Provider Demographics
NPI:1528095585
Name:BARUDIN, BARRY S (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:S
Last Name:BARUDIN
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 1:402 S BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-2103
Mailing Address - Country:US
Mailing Address - Phone:616-907-7176
Mailing Address - Fax:
Practice Address - Street 1:402 S BALDWIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2103
Practice Address - Country:US
Practice Address - Phone:616-907-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032178208000000X
WI37258-020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE97432Medicare UPIN