Basic Information
| Provider Information | |||||||||
| NPI: | 1942202122 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARRETTO | ||||||||
| FirstName: | RAFAEL | ||||||||
| MiddleName: | LIMGENCO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4967 CROOKS RD | ||||||||
| Address2: | STE. 130 | ||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480985801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489521601 | ||||||||
| FaxNumber: | 2489521614 | ||||||||
| Practice Location | |||||||||
| Address1: | 11800 E TWELVE MILE RD | ||||||||
| Address2: | INPTIENT CONSULTANTS OF MICHIGAN | ||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344640887 | ||||||||
| FaxNumber: | 7344020254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 01/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101013775 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 4301013775 | MI | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1942202122 | 01 | MI | NPI # | OTHER | RB013775 | 01 | MI | BCBSM | OTHER | 70-0-F32947-0 | 01 | MI | BCBS CPIN # | OTHER | 4846763 | 05 | MI | MEDICAID |