Healthcare Provider Details

I. General information

NPI: 1578727061
Provider Name (Legal Business Name): BARRY EVAN NORMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 CHERI CT
KIMBERLY ID
83341-5430
US

IV. Provider business mailing address

707 CHERI CT
KIMBERLY ID
83341-5430
US

V. Phone/Fax

Practice location:
  • Phone: 773-726-2151
  • Fax:
Mailing address:
  • Phone: 773-726-2151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9771254
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number18221
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: