Individual
DR. CLARENCE RICHARD BARNETT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1020 4TH AVE, LAKE ODESSA, MI 48849-1004
(616) 374-8881
(616) 374-4220
Mailing address
650 LAKEVIEW DR, LAKE ODESSA, MI 48849-1274
(616) 374-8259
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301047150
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0100558
PHP LANSING PLAN
MI
01
—
0130191
PHP KALAMAZOO PLAN
MI
01
—
0170558
PHP MEDICAID PLAN
MI
01
—
0340028
BCBS
MI
05
—
1560127
—
MI
Enumeration date
03/23/2006
Last updated
07/09/2007
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