Provider Demographics
NPI:1922500461
Name:BARACH, PAUL RANDALL (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RANDALL
Last Name:BARACH
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 S DEARBORN ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1823
Mailing Address - Country:US
Mailing Address - Phone:773-612-7039
Mailing Address - Fax:
Practice Address - Street 1:711 S DEARBORN ST UNIT 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1823
Practice Address - Country:US
Practice Address - Phone:773-612-7039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC189228207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology