Provider Demographics
NPI:1225066152
Name:EITEL, BARRY CRAIG (MSW)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:CRAIG
Last Name:EITEL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 PIEHL RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49267-8710
Mailing Address - Country:US
Mailing Address - Phone:419-260-5552
Mailing Address - Fax:
Practice Address - Street 1:4315 PIEHL RD
Practice Address - Street 2:
Practice Address - City:OTTAWA LAKE
Practice Address - State:MI
Practice Address - Zip Code:49267-8710
Practice Address - Country:US
Practice Address - Phone:419-260-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010630871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR66515Medicare UPIN
MA0M39280009Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MION53100Medicare ID - Type Unspecified