Provider Demographics
NPI:1255548434
Name:BARRY BEAN DPM PLLC
Entity type:Organization
Organization Name:BARRY BEAN DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-355-4888
Mailing Address - Street 1:21721 W 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3717
Mailing Address - Country:US
Mailing Address - Phone:248-355-4888
Mailing Address - Fax:248-355-2565
Practice Address - Street 1:21721 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3717
Practice Address - Country:US
Practice Address - Phone:248-355-4888
Practice Address - Fax:248-355-2565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBB000712213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4856318250OtherBCBSM
MI2581088Medicaid
MI4856318250OtherBCBSM
MI5635457Medicare ID - Type Unspecified
MI2581088Medicaid