Provider Demographics
NPI:1134102593
Name:BARNETT, BRUCE A (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:BARNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 HUGHES DR
Mailing Address - Street 2:HMT STE 640
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3845
Mailing Address - Country:US
Mailing Address - Phone:419-291-2207
Mailing Address - Fax:419-479-6998
Practice Address - Street 1:2121 HUGHES DR
Practice Address - Street 2:STE 640
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3845
Practice Address - Country:US
Practice Address - Phone:419-291-2207
Practice Address - Fax:419-479-6998
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350487732080P0203X
OH35048773B2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
116024OtherGLHP
MI5202241Medicaid
OH000000520827OtherANTHEM
8812OtherHEALTH PLAN OF MI
OH000000219638OtherUNISON
OH4262383OtherAETNA
OH0740783Medicaid
OH00277OtherPARAMOUNT
OHBA4062262Medicare PIN
OHBA4062261Medicare ID - Type Unspecified
OH4262383OtherAETNA