Provider Demographics
NPI:1447760111
Name:BARNES-BEY, DARRELL (CPRM-M)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:
Last Name:BARNES-BEY
Suffix:
Gender:M
Credentials:CPRM-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12775 PLYMOUTH RD APT 26
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-3790
Mailing Address - Country:US
Mailing Address - Phone:313-397-5702
Mailing Address - Fax:
Practice Address - Street 1:2081 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-1105
Practice Address - Country:US
Practice Address - Phone:313-895-0500
Practice Address - Fax:313-397-5702
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM-00267175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist