Provider Demographics
NPI:1194833632
Name:BARAKAT, SAFWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SAFWAN
Middle Name:
Last Name:BARAKAT
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 1:1425 N MCLEAN BLVD
Mailing Address - Street 2:STE 550
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5723
Mailing Address - Country:US
Mailing Address - Phone:847-741-1610
Mailing Address - Fax:847-741-1798
Practice Address - Street 1:1425 N MCLEAN BLVD
Practice Address - Street 2:STE 550
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5723
Practice Address - Country:US
Practice Address - Phone:847-741-1610
Practice Address - Fax:847-741-1798
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL246050Medicare ID - Type Unspecified
ILD10212Medicare UPIN