Provider Demographics
NPI:1306969944
Name:BARNETT, RUTH DARCEL (DO)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:DARCEL
Last Name:BARNETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15121 W MCNICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-3716
Mailing Address - Country:US
Mailing Address - Phone:313-270-4450
Mailing Address - Fax:313-270-4470
Practice Address - Street 1:15121 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3716
Practice Address - Country:US
Practice Address - Phone:313-270-4450
Practice Address - Fax:313-270-4470
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009310207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3360036Medicaid
MIP16260Medicare UPIN