Provider Demographics
NPI:1114988417
Name:RAPAPORT, BARRY A (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:A
Last Name:RAPAPORT
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:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-6003
Mailing Address - Country:US
Mailing Address - Phone:847-964-9883
Mailing Address - Fax:847-964-9830
Practice Address - Street 1:1418 KENTON RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-2314
Practice Address - Country:US
Practice Address - Phone:847-964-9883
Practice Address - Fax:847-964-9830
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363553539174400000X
IL208D00000X207R00000X
IL036064257207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360642571Medicaid
IL0360642571Medicaid
ILC46060Medicare UPIN