MEDICARE: BARRY P ATLAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01615754	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1073513305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY P ATLAS M.D.

Provider Business Mailing Address
First Line	:	6374 N LINCOLN AVE
Second Line	:	SUITE 312
City	:	CHICAGO
State	:	IL
Zip	:	60659-1275
Country	:	US
Telephone Number	:	773-588-7710
Fax Number	:	773-561-8977

Provider Business Practice Location Address
First Line	:	6374 N LINCOLN AVE
Second Line	:	SUITE 312
City	:	CHICAGO
State	:	IL
Zip	:	60659-1275
Country	:	US
Telephone Number	:	773-588-7710
Fax Number	:	773-561-8977

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	12/17/2007

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