Healthcare Provider Details

I. General information

NPI: 1912054990
Provider Name (Legal Business Name): ROBERT J. BARTUCCI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 S. ROUTE 31
CRYSTAL LAKE IL
60014
US

IV. Provider business mailing address

PO BOX 7128
ALGONQUIN IL
60102-7128
US

V. Phone/Fax

Practice location:
  • Phone: 779-220-5500
  • Fax: 779-220-5184
Mailing address:
  • Phone: 941-416-4589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0045008
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME0045008
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.067370
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME0045008
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMD49507
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD49507
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: