Provider Demographics
NPI:1265434567
Name:BARKER, DAVID BRADFORD (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRADFORD
Last Name:BARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-0323
Mailing Address - Country:US
Mailing Address - Phone:734-246-6046
Mailing Address - Fax:734-324-3618
Practice Address - Street 1:2333 BIDDLE ST
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4668
Practice Address - Country:US
Practice Address - Phone:734-246-6046
Practice Address - Fax:734-324-3618
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301041890208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI118257OtherDEPARTMENT OF LABOR AND I
MI2508204793OtherBCBSM
MI4413009Medicaid
MI10349265800OtherUS POSTAL SERVICE
MIA77168OtherHAP
MIP01180001Medicare PIN
MI10349265800OtherUS POSTAL SERVICE