Provider Demographics
NPI:1134361066
Name:ENSIGN MEDICAL INCORPORATED
Entity type:Organization
Organization Name:ENSIGN MEDICAL INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:630-810-0358
Mailing Address - Street 1:2200 S MAIN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5366
Mailing Address - Country:US
Mailing Address - Phone:630-810-0358
Mailing Address - Fax:630-810-5404
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:SUITE 3E
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-810-0358
Practice Address - Fax:630-810-5404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068503207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty