Provider Demographics
NPI:1518356690
Name:BARRY, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BARRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3879 PACKARD ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2011
Mailing Address - Country:US
Mailing Address - Phone:734-531-6431
Mailing Address - Fax:
Practice Address - Street 1:3879 PACKARD RD
Practice Address - Street 2:UNIT B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108
Practice Address - Country:US
Practice Address - Phone:734-531-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704186744163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice