Healthcare Provider Details

I. General information

NPI: 1285154773
Provider Name (Legal Business Name): DEIRDRE MCCOLGAN BARTLETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 12/04/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE BOX #37
CHICAGO IL
60611
US

IV. Provider business mailing address

225 E CHICAGO AVE BOX #37
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6160
  • Fax: 312-227-9405
Mailing address:
  • Phone: 312-227-6160
  • Fax: 312-227-9405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301112357
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036156792
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: