Basic Information
| Provider Information | |||||||||
| NPI: | 1437866571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PUTMAN | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | CPNP-PC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GUTMANN | ||||||||
| OtherFirstName: | BARBARA | ||||||||
| OtherMiddleName: | JANE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3231 GLACIER CT | ||||||||
| Address2: | |||||||||
| City: | DEXTER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481309395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484445863 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14288 E. OLD US 12 | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CHELSEA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481181889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344759175 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2022 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4704304104 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.