Provider Demographics
NPI:1548385768
Name:MINEROF, BARRY W (DPM)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:W
Last Name:MINEROF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3935 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3706
Mailing Address - Country:US
Mailing Address - Phone:773-762-2000
Mailing Address - Fax:773-762-3350
Practice Address - Street 1:3935 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3706
Practice Address - Country:US
Practice Address - Phone:773-762-2000
Practice Address - Fax:773-762-3350
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004469213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60010797OtherBLUE CROSS BLUE SHIELD
IL236961OtherHARMONY HEALTH
IL480024746OtherRAILROAD MEDICARE
IL5885990001Medicare NSC
IL480024746OtherRAILROAD MEDICARE
IL200130Medicare PIN