=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245426980
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMEER A. BARKATULLAH M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2007
-----------------------------------------------------
Last Update Date | 11/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 396 REMINGTON BLVD SUITE 260
-----------------------------------------------------
City | BOLINGBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60440-4302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-312-2590
-----------------------------------------------------
Fax | 630-226-0669
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 396 REMINGTON BLVD STE 260
-----------------------------------------------------
City | BOLINGBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60440-4302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-312-2590
-----------------------------------------------------
Fax | 630-226-0669
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 036.117909
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------