Healthcare Provider Details

I. General information

NPI: 1811919681
Provider Name (Legal Business Name): BARBARA JANE DEAL M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 CHILDRENS PLAZA BOX 21
CHICAGO IL
60614
US

IV. Provider business mailing address

2300 CHILDRENS PLAZA BOX 21
CHICAGO IL
60614
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-4553
  • Fax: 773-880-8111
Mailing address:
  • Phone: 773-880-4553
  • Fax: 773-880-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number036061402
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: