Healthcare Provider Details

I. General information

NPI: 1326117383
Provider Name (Legal Business Name): BARRY M. SUMMERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N HALSTED ST STE 401
CHICAGO IL
60657-9268
US

IV. Provider business mailing address

3000 N HALSTED ST STE 401
CHICAGO IL
60657-9268
US

V. Phone/Fax

Practice location:
  • Phone: 773-935-5985
  • Fax: 773-935-5478
Mailing address:
  • Phone: 773-935-5985
  • Fax: 773-935-5478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036083079
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036083079
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036-135695
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number036-135695
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: