Provider Demographics
NPI:1629171152
Name:BARTZ, ANNETTE R (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:R
Last Name:BARTZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11601 S PULASKI RD
Mailing Address - Street 2:WORTH TOWNSHIP CLINIC
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-1611
Mailing Address - Country:US
Mailing Address - Phone:708-371-3393
Mailing Address - Fax:708-371-2542
Practice Address - Street 1:11601 S PULASKI RD
Practice Address - Street 2:WORTH TOWNSHIP CLINIC
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-1611
Practice Address - Country:US
Practice Address - Phone:708-371-3393
Practice Address - Fax:708-371-2542
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004094213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL480007120OtherRAILROAD MEDICARE
IL6000166347OtherBLUE CROSS BLUE SHIELD
ILIL3149OtherMEDICARE PTAN
IL788290Medicare ID - Type Unspecified
U06544Medicare UPIN