1730119678 NPI number — DR. MUNTHER A BARAKAT M.A. AND PSY.D.

Table of content: DR. MUNTHER A BARAKAT M.A. AND PSY.D. (NPI 1730119678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730119678 NPI number — DR. MUNTHER A BARAKAT M.A. AND PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARAKAT
Provider First Name:
MUNTHER
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.A. AND PSY.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730119678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2065 W GREENBRIAR CT
Provider Second Line Business Mailing Address:
APT 3A
Provider Business Mailing Address City Name:
OAK CREEK
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53154-8150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-304-7294
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10500 W LOOMIS RD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53132-8111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-858-1014
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  2780-057 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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