Provider Demographics
NPI:1275736035
Name:BARNES, MICHELLE MARCY (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARCY
Last Name:BARNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:CATHERINE
Other - Last Name:MARCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:840 S WOOD ST # MC856
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-1125
Mailing Address - Fax:312-413-0243
Practice Address - Street 1:840 S WOOD ST # MC856
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4325
Practice Address - Country:US
Practice Address - Phone:312-996-1125
Practice Address - Fax:312-413-0243
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121593208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine