Provider Demographics
NPI:1639136971
Name:BARTT, RUSSELL E (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:E
Last Name:BARTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:499 E HAMPDEN AVE STE 360
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3877
Mailing Address - Country:US
Mailing Address - Phone:303-781-4485
Mailing Address - Fax:720-274-0064
Practice Address - Street 1:499 E HAMPDEN AVE STE 360
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3877
Practice Address - Country:US
Practice Address - Phone:303-781-4485
Practice Address - Fax:720-274-0064
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360906402084N0400X
NE271092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCS336052256OtherIL DEPT OF FE PROF REG
IL036090640Medicaid
BB3793189OtherFED DRUG ENFORCEMENT AGEN
G60316Medicare UPIN
ILCS336052256OtherIL DEPT OF FE PROF REG