Provider Demographics
NPI:1760473235
Name:BARRETT, MICHAEL J (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:BARRETT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 MADISON OAK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3920
Mailing Address - Country:US
Mailing Address - Phone:210-479-3233
Mailing Address - Fax:512-485-0147
Practice Address - Street 1:540 MADISON OAK DR STE 210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3920
Practice Address - Country:US
Practice Address - Phone:210-479-3233
Practice Address - Fax:512-485-0147
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1586213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A4609OtherBCBS
TX152014001Medicaid
TXTXB109323Medicare PIN
TX8A4609OtherBCBS
TX8A4609Medicare ID - Type Unspecified