Healthcare Provider Details
I. General information
NPI: 1770816357
Provider Name (Legal Business Name): BARRINGTON WELLNESS GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/14/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1585 BARRINGTON RD SUITE 605
HOFFMAN ESTATES IL
60169-1090
US
IV. Provider business mailing address
PO BOX 958292
HOFFMAN ESTATES IL
60195-8292
US
V. Phone/Fax
- Phone: 847-755-5588
- Fax: 847-755-1166
- Phone: 847-755-5588
- Fax: 847-755-1166
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207VG0400X |
| Taxonomy | Gynecology Physician |
| License Number | 036059972 |
| License Number State | IL |
VIII. Authorized Official
Name: DR.
RAVI
K
TRIVEDI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-755-5588