Provider Demographics
NPI:1184625659
Name:BARTH, GREGORY L (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:BARTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2211 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3711
Mailing Address - Country:US
Mailing Address - Phone:612-871-1144
Mailing Address - Fax:612-871-2012
Practice Address - Street 1:2211 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3711
Practice Address - Country:US
Practice Address - Phone:612-871-1144
Practice Address - Fax:612-871-2012
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN36229207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN104241OtherUCARE
MN88308OtherAMERICA'S PPO
MN10-28847OtherMEDICA
MN1000374OtherPREFERRED ONE
MN2M769BAOtherBLUE CROSS
MN10-00010OtherMEDICA PRIMARY - GROUP #
MN276365600Medicaid
WI31969900OtherEDS - WISCONSIN MEDICAID
IA0911388OtherIOWA MEDICAID
MN1000374OtherPREFERRED ONE
MN2M769BAOtherBLUE CROSS