Doctor Name: | DR. ANDREA GRUBB BARTHWELL |
NPI Number: | 1396093720 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 036.063796 |
Business Practice Address: | 610 S Maple Ave Suite 3400 Oak Park, IL - 603041091 |
Business Phone Number: | 7086134750 |
Business Fax Number: | 7086134754 |
Mailing Address: | 610 S Maple Ave, Suite 3400 OAK PARK |
State: | IL |
Postal Code: | 603041091 |
Phone Number: | 7086134750 |
Fax Number: | 7086134754 |
NPI Enumeration Date: | 08/15/2012 |
NPI Last Update Date: | 08/15/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 036.063796 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |