Provider Demographics
NPI:1831312909
Name:BARTASIUS, VIDA M (CNM)
Entity Type:Individual
Prefix:MRS
First Name:VIDA
Middle Name:M
Last Name:BARTASIUS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 W JOE ORR RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-1744
Mailing Address - Country:US
Mailing Address - Phone:708-709-7470
Mailing Address - Fax:
Practice Address - Street 1:233 W JOE ORR RD
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1744
Practice Address - Country:US
Practice Address - Phone:708-709-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative Medicine