MEDICARE: DR. BARRY M. SUMMERS 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	207Q00000X	Family Medicine Physician	036083079	IL
2	208600000X	Surgery Physician	036-135695	IL
3	2086S0129X	Vascular Surgery Physician	036-135695	IL
4	174400000X	Specialist	036083079	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1621416	OTHER	IL	BC/BS #
2	36416906625638	OTHER	IL	ADVOCATE HEALTH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	36416906604691	OTHER	IL	ADVOCATE AHC/HUMANA

General Provider Information

NPI Number	:	1326117383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY M. SUMMERS M.D.

Provider Business Mailing Address
First Line	:	3000 N HALSTED ST STE 401
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-9268
Country	:	US
Telephone Number	:	773-935-5985
Fax Number	:	773-935-5478

Provider Business Practice Location Address
First Line	:	3000 N HALSTED ST STE 401
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-9268
Country	:	US
Telephone Number	:	773-935-5985
Fax Number	:	773-935-5478

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	09/28/2022

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