Provider Demographics
NPI:1861450637
Name:BARSANTI, CARL MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:MICHAEL
Last Name:BARSANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 S HIGHLAND AVE
Mailing Address - Street 2:230
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5371
Mailing Address - Country:US
Mailing Address - Phone:630-932-2040
Mailing Address - Fax:866-932-1513
Practice Address - Street 1:2340 S HIGHLAND AVE
Practice Address - Street 2:230
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5371
Practice Address - Country:US
Practice Address - Phone:630-932-2040
Practice Address - Fax:866-932-1513
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02215074OtherBLUE SHIELD PROVIDER NUMB
IL695351Medicare PIN
ILD15058Medicare UPIN