Provider Demographics
NPI:1467733097
Name:BARNHART, MICAL JOEL (RN)
Entity Type:Individual
Prefix:MR
First Name:MICAL
Middle Name:JOEL
Last Name:BARNHART
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 JOHN R ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-4030
Mailing Address - Country:US
Mailing Address - Phone:313-831-1911
Mailing Address - Fax:313-831-1931
Practice Address - Street 1:5250 JOHN R ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-4030
Practice Address - Country:US
Practice Address - Phone:313-831-1911
Practice Address - Fax:313-831-1931
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704283397163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)