Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 036046311 | IL |
NPI | 1013018449 |
---|---|
Provider Name | Barry Sadegi |
First Address | Downers Grove, IL 60515-1552 |
Second Address | Downers Grove, IL 60515-1552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 19/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0031601938 | BCBS (01) | IL |
036046311 | (05) | IL |
1400955817 | CLIA (01) | IL |
207Q00000X | TAXONOMY (01) | IL |
2239111 | CIGNA (01) | IL |
363553540 | TAXID (01) | IL |
K26224 | MEDICARE PTAN (01) | IL |