Healthcare Provider Details

I. General information

NPI: 1790245959
Provider Name (Legal Business Name): WILLIAM NATHAN BARGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST # 3AA
CHICAGO IL
60612-4795
US

IV. Provider business mailing address

231 ALBERT SABIN WAY # 0535
CINCINNATI OH
45267-0535
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-3627
  • Fax:
Mailing address:
  • Phone: 513-584-0397
  • Fax: 513-584-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036165351
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036165351
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: