Provider Demographics
NPI:1639178445
Name:BARNUM, GRANT MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:MICHAEL
Last Name:BARNUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:54 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1870 BAGNELL DAM BLVD
Practice Address - Street 2:
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049-8658
Practice Address - Country:US
Practice Address - Phone:573-365-2318
Practice Address - Fax:573-365-3009
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODOR4GO2207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242978211Medicaid
MOP00303899OtherRAILROAD MEDICARE
MO037233557Medicare PIN
MOE47795Medicare UPIN