Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 036149082 | IL |
NPI | 1124318837 |
---|---|
Provider Name | Dr. Ryan Peter Bartkus |
First Address | Elk Grove Village, IL 60007-3362 |
Second Address | Elk Grove Village, IL 60007-3362 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2011 |
Last Update Date | 04/11/2020 |