Provider Demographics
NPI:1558536367
Name:BARNABAS MEDICAL ASSOCIATES SC
Entity Type:Organization
Organization Name:BARNABAS MEDICAL ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BARNABAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-561-4440
Mailing Address - Street 1:5015 N PAULINA ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2756
Mailing Address - Country:US
Mailing Address - Phone:773-561-4440
Mailing Address - Fax:773-561-9211
Practice Address - Street 1:5015 N PAULINA ST
Practice Address - Street 2:SUITE 225
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2756
Practice Address - Country:US
Practice Address - Phone:773-561-4440
Practice Address - Fax:773-561-9211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042006296/ 036061422207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036061422Medicaid
IL776460Medicare PIN
ILC41719Medicare UPIN