Provider Demographics
NPI:1962494005
Name:BARKETT, GUSTAV K (DO)
Entity Type:Individual
Prefix:DR
First Name:GUSTAV
Middle Name:K
Last Name:BARKETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-672-6600
Mailing Address - Fax:231-728-4691
Practice Address - Street 1:1675 LEAHY ST
Practice Address - Street 2:SUITE 201A
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5500
Practice Address - Country:US
Practice Address - Phone:231-672-6600
Practice Address - Fax:231-728-4691
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008836207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1592944Medicaid
MI4999566Medicaid
MI1592944Medicaid