Provider Demographics
NPI:1447920384
Name:BARFIELD, ANTWAIN LARRY
Entity type:Individual
Prefix:MR
First Name:ANTWAIN
Middle Name:LARRY
Last Name:BARFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5256 N 61ST ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-3101
Mailing Address - Country:US
Mailing Address - Phone:414-303-1655
Mailing Address - Fax:
Practice Address - Street 1:5256 N 61ST ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-3101
Practice Address - Country:US
Practice Address - Phone:414-303-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIB6140129126300343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI46-0962089Medicaid