Provider Demographics
NPI:1134100688
Name:ALTSHULER, BARRY A (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:A
Last Name:ALTSHULER
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 1:820 E TERRA COTTA AVE
Mailing Address - Street 2:SUITE 226
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3649
Mailing Address - Country:US
Mailing Address - Phone:815-455-2100
Mailing Address - Fax:815-455-3284
Practice Address - Street 1:820 E TERRA COTTA AVE
Practice Address - Street 2:SUITE 226
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3649
Practice Address - Country:US
Practice Address - Phone:815-455-2100
Practice Address - Fax:815-455-3284
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071366208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071366Medicaid