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General NPI Number Information
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NPI Number | 1639215460
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Entity Type | Individual
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Provider Name | JOHN BARTOK PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 899 SKOKIE BLVD SUITE 230
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City | NORTHBROOK
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State | IL
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Zip | 60062-4019
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Country | US
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Telephone | 847-714-9492
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Fax |
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Provider Business Mailing Address
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Address Line | 910 FOREST AVE
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City | DEERFIELD
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State | IL
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Zip | 60015-2919
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Country | US
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Telephone | 847-714-9494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State | IL
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