Provider Demographics
NPI:1164404133
Name:MOSS, BARRY M (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:M
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:30840 NORTHWESTERN HWY
Mailing Address - Street 2:STE 300
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:248-932-1250
Mailing Address - Fax:248-932-8977
Practice Address - Street 1:30840 NORTHWESTERN HWY
Practice Address - Street 2:STE 300
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-932-1250
Practice Address - Fax:248-932-8977
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-07-15
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Provider Licenses
StateLicense IDTaxonomies
MI4301035120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700F319250OtherBLUE SHIELD
MI1164404133Medicaid
MI0N53930006Medicare PIN
MI1164404133Medicaid