Provider Demographics
NPI:1275558629
Name:BARTOLOMEO, VINCE (MD)
Entity Type:Individual
Prefix:
First Name:VINCE
Middle Name:
Last Name:BARTOLOMEO
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 1:1415 W 47TH ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6136
Mailing Address - Country:US
Mailing Address - Phone:708-579-9375
Mailing Address - Fax:
Practice Address - Street 1:1415 W 47TH ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6136
Practice Address - Country:US
Practice Address - Phone:708-579-9375
Practice Address - Fax:708-579-9378
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine