Provider Demographics
NPI:1124225602
Name:RUTH BARNETT,DO,PC
Entity Type:Organization
Organization Name:RUTH BARNETT,DO,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-270-4450
Mailing Address - Street 1:15121 W MCNICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-3716
Mailing Address - Country:US
Mailing Address - Phone:313-270-4450
Mailing Address - Fax:313-270-4470
Practice Address - Street 1:15121 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3716
Practice Address - Country:US
Practice Address - Phone:313-270-4450
Practice Address - Fax:313-270-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009310207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101009310OtherLICENSE
MI3360036Medicaid
MI3360036Medicaid