Healthcare Provider Details

I. General information

NPI: 1457358673
Provider Name (Legal Business Name): GREATER BARRINGTON FAMILY HEALTH CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EXECUTIVE CT BUILDING1, SUITE 2
SOUTH BARRINGTON IL
60010-9533
US

IV. Provider business mailing address

PO BOX 957258
HOFFMAN ESTATES IL
60195-7258
US

V. Phone/Fax

Practice location:
  • Phone: 847-382-4466
  • Fax: 847-382-4499
Mailing address:
  • Phone: 847-382-4466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DAVID A BIRNBAUM
Title or Position: OWNER
Credential: M.D.
Phone: 847-382-4466