Provider Demographics
NPI:1245426980
Name:BARKATULLAH, SAMEER A (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMEER
Middle Name:A
Last Name:BARKATULLAH
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 1:396 REMINGTON BLVD
Mailing Address - Street 2:STE 260
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4302
Mailing Address - Country:US
Mailing Address - Phone:630-312-2590
Mailing Address - Fax:630-226-0669
Practice Address - Street 1:396 REMINGTON BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-4302
Practice Address - Country:US
Practice Address - Phone:630-312-2590
Practice Address - Fax:630-226-0669
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.117909207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
399980OtherMEDICARE GROUP PTAN