Provider Demographics
NPI:1174626519
Name:BARBER, DANIEL ARTHUR (PA-C)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ARTHUR
Last Name:BARBER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 584
Mailing Address - Street 2:7990 WEST WX AVE
Mailing Address - City:SCHOOLCRAFT
Mailing Address - State:MI
Mailing Address - Zip Code:49087-0584
Mailing Address - Country:US
Mailing Address - Phone:269-679-3760
Mailing Address - Fax:
Practice Address - Street 1:2000 GREEN RD STE 300
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1575
Practice Address - Country:US
Practice Address - Phone:734-995-3764
Practice Address - Fax:734-995-2913
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004951363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47451025Medicaid
MI230015Medicare Oscar/Certification
803455Medicare ID - Type Unspecified
MI238506Medicare Oscar/Certification
MI238599Medicare Oscar/Certification
CO47451025Medicaid
P52215Medicare UPIN