Provider Demographics
NPI:1013018449
Name:SADEGI, BARRY (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:SADEGI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 HIGHLAND AVE
Mailing Address - Street 2:3B
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1552
Mailing Address - Country:US
Mailing Address - Phone:630-434-9300
Mailing Address - Fax:630-434-9302
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:3B
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-434-9300
Practice Address - Fax:630-434-9302
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046311207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1400955817OtherCLIA
IL363553540OtherTAXID
IL207Q00000XOtherTAXONOMY
ILK26224OtherMEDICARE PTAN
IL0031601938OtherBCBS
IL2239111OtherCIGNA
IL036046311Medicaid