Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 5101015127 | MI |
Y | 207RP1001X | Pulmonary Disease | 5101015127 | MI |
NPI | 1073726329 |
---|---|
Provider Name | Bryan G Barnosky |
First Address | Shelby Township, MI 48315-3140 |
Second Address | Saint Clair Shores, MI 48081-3370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 18/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0E00425 | BCBSM (01) | MI |
5212785 | (05) | MI |