Provider Demographics
NPI:1508824152
Name:BARAK, ANDREW PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PAUL
Last Name:BARAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2323 E PARIS AVE SE
Mailing Address - Street 2:STE 102
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2414
Mailing Address - Country:US
Mailing Address - Phone:616-285-3733
Mailing Address - Fax:616-285-5960
Practice Address - Street 1:6130 PRESTLEY MILL RD STE C
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2288
Practice Address - Country:US
Practice Address - Phone:678-838-3903
Practice Address - Fax:678-838-7454
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAB007458207Y00000X
GA67354207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126984DMedicaid
MI2121408Medicaid
MI0454110994OtherBCBS
MI0454110994OtherBCBS