Provider Demographics
NPI:1194706580
Name:MEYER, BARRY S (DO)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:S
Last Name:MEYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23423 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-1927
Mailing Address - Country:US
Mailing Address - Phone:586-755-5400
Mailing Address - Fax:586-755-0066
Practice Address - Street 1:23423 RYAN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-1927
Practice Address - Country:US
Practice Address - Phone:586-755-5400
Practice Address - Fax:586-755-0066
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G16142Medicare UPIN