Provider Demographics
NPI:1003097619
Name:BARRY M SUMMERS,MD,SC
Entity Type:Organization
Organization Name:BARRY M SUMMERS,MD,SC
Other - Org Name:CHICAGOLAND COMPLETE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JARKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-935-5985
Mailing Address - Street 1:3000 N HALSTED ST STE 401
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-9268
Mailing Address - Country:US
Mailing Address - Phone:773-935-5985
Mailing Address - Fax:773-935-5478
Practice Address - Street 1:3000 N HALSTED ST STE 401
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-9268
Practice Address - Country:US
Practice Address - Phone:773-935-5985
Practice Address - Fax:773-935-5478
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHICAGOLAND COMPLETE HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-26
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083079174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209753Medicare PIN