Provider Demographics
NPI:1528010071
Name:BARG, MICHELLE R (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:BARG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:R
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:916 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LINN
Mailing Address - State:MO
Mailing Address - Zip Code:65051-9780
Mailing Address - Country:US
Mailing Address - Phone:573-897-2525
Mailing Address - Fax:573-897-3566
Practice Address - Street 1:916 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LINN
Practice Address - State:MO
Practice Address - Zip Code:65051-9780
Practice Address - Country:US
Practice Address - Phone:573-897-2525
Practice Address - Fax:573-897-3566
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003018324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H94955Medicare UPIN