Provider Demographics
NPI:1497718597
Name:BARRY, MICHAEL D (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:BARRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 S MERCY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0425
Mailing Address - Country:US
Mailing Address - Phone:480-955-0900
Mailing Address - Fax:480-955-0800
Practice Address - Street 1:3420 S MERCY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0419
Practice Address - Country:US
Practice Address - Phone:480-955-0900
Practice Address - Fax:480-955-0800
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2782207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ344044Medicaid
AZZ226786OtherMEDICARE PTAN