Healthcare Provider Details

I. General information

NPI: 1699036558
Provider Name (Legal Business Name): MATTHEW BARHIGHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE # 73
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 443-257-1441
  • Fax:
Mailing address:
  • Phone: 443-257-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0055597
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number036146666
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: