Provider Demographics
NPI:1871648444
Name:BARNES-GRAIN, ANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:
Last Name:BARNES-GRAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2609 ELECTRIC AVE STE D
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6589
Mailing Address - Country:US
Mailing Address - Phone:810-966-3000
Mailing Address - Fax:810-987-1060
Practice Address - Street 1:2609 ELECTRIC AVE STE D
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6589
Practice Address - Country:US
Practice Address - Phone:810-966-3000
Practice Address - Fax:810-987-1060
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010711072080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3452530Medicaid
MIF71594Medicare UPIN