Provider Demographics
NPI:1487762035
Name:BARNHART, BRETT MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:MICHAEL
Last Name:BARNHART
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 1:180 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-2608
Mailing Address - Country:US
Mailing Address - Phone:309-647-0201
Mailing Address - Fax:309-649-5302
Practice Address - Street 1:180 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-2608
Practice Address - Country:US
Practice Address - Phone:309-647-0201
Practice Address - Fax:309-649-8943
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113333207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113333Medicaid
IL611333OtherOSF HEALTHPLANS
IL02922981OtherBCBS
ILIL0149OtherJOHN DEERE
IL0062839OtherUMWA
IL107345OtherHEALTH ALLIANCE
IL716358OtherHEALTHLINK
ILP00291217OtherRR MEDICARE PIN
ILCG5172OtherRR MEDICARE GROUP
IL611333OtherOSF HEALTHPLANS
ILI37416Medicare UPIN
IL107345OtherHEALTH ALLIANCE