Provider Demographics
NPI:1578526976
Name:BARR, LONSON LEE (DO)
Entity Type:Individual
Prefix:MR
First Name:LONSON
Middle Name:LEE
Last Name:BARR
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 1:1945 BOSTON ST SE
Mailing Address - Street 2:STE 303
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506
Mailing Address - Country:US
Mailing Address - Phone:616-246-6262
Mailing Address - Fax:616-246-8737
Practice Address - Street 1:1945 BOSTON ST SE
Practice Address - Street 2:STE 303
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506
Practice Address - Country:US
Practice Address - Phone:616-246-6262
Practice Address - Fax:616-246-8737
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005711208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1767521Medicaid
MI5411537Medicare ID - Type Unspecified
MI1767521Medicaid