MEDICARE: REGINA BART PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		IL

General Provider Information

NPI Number	:	1083656284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA BART PA

Provider Business Mailing Address
First Line	:	8930 WAUKEGAN RD
Second Line	:	SUITE 200 - ATTN: RAQUEL LEON
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2126
Country	:	US
Telephone Number	:	847-324-3976
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 N LAKE SHORE DR
Second Line	:	SUITE 1028
City	:	CHICAGO
State	:	IL
Zip	:	60611-4546
Country	:	US
Telephone Number	:	312-664-6848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/09/2007

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