Provider Demographics
NPI:1740539220
Name:BARTLETT MEDICAL ASSOCIATES SC
Entity type:Organization
Organization Name:BARTLETT MEDICAL ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARIONETTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:JAYAPRAKASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-289-6024
Mailing Address - Street 1:385 BARTLETT PLZ
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4234
Mailing Address - Country:US
Mailing Address - Phone:630-289-6024
Mailing Address - Fax:630-289-8400
Practice Address - Street 1:385 BARTLETT PLZ
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4234
Practice Address - Country:US
Practice Address - Phone:630-289-6024
Practice Address - Fax:630-289-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty