Provider Demographics
NPI:1629063201
Name:BARTELT, DONA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:DONA
Middle Name:Y
Last Name:BARTELT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DONA
Other - Middle Name:Y
Other - Last Name:KORTAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:22285 PEPPER RD
Mailing Address - Street 2:#311
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010
Mailing Address - Country:US
Mailing Address - Phone:847-382-4410
Mailing Address - Fax:847-382-4451
Practice Address - Street 1:22285 PEPPER RD
Practice Address - Street 2:#311
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010
Practice Address - Country:US
Practice Address - Phone:847-382-4410
Practice Address - Fax:847-382-4451
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
K00761Medicare ID - Type UnspecifiedLOCALITY 15
K00762Medicare ID - Type UnspecifiedLOCALITY 99
G05093Medicare UPIN