Provider Demographics
NPI:1326117383
Name:SUMMERS, BARRY M (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:M
Last Name:SUMMERS
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 1:3000 N HALSTED ST STE 401
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-9268
Mailing Address - Country:US
Mailing Address - Phone:773-935-5985
Mailing Address - Fax:773-935-5478
Practice Address - Street 1:3000 N HALSTED ST STE 401
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-9268
Practice Address - Country:US
Practice Address - Phone:773-935-5985
Practice Address - Fax:773-935-5478
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083079207Q00000X, 174400000X
IL036-135695208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1621416OtherBC/BS #
IL36416906625638OtherADVOCATE HEALTH
IL036083079Medicaid
IL36416906604691OtherADVOCATE AHC/HUMANA
IL1621416OtherBC/BS #
IL36416906625638OtherADVOCATE HEALTH