Provider Demographics
NPI:1780735308
Name:SUDHOLT, BARBARA ANN (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:SUDHOLT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 W LINCOLN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1900
Mailing Address - Country:US
Mailing Address - Phone:618-235-4883
Mailing Address - Fax:618-235-9573
Practice Address - Street 1:340 W LINCOLN ST STE 300
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1900
Practice Address - Country:US
Practice Address - Phone:618-235-4883
Practice Address - Fax:618-235-9573
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36078217207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2210404001OtherCIGNA
IL4466070OtherAETNA
IL88170OtherHEALTH ALLIANCE
IL371067092003OtherPRUDENTIAL
ILL013062OtherTRICARE
IL122577OtherHEALTHLINK
IL300242OtherHEALTH PARTNERS
IL08215136OtherFEDERAL BLUE CROSS
IL48-09006OtherUNITED HEALTHCARE
MOBLC21543OtherBLUE CHOICE OF MISSOURI
IL235930OtherHARMONY
MO28568OtherANTHEM
IL36078217Medicaid
ILCF6007OtherRAILROAD MEDICARE
IL8215136OtherBCBS OF IL
IL300242OtherHEALTH PARTNERS
IL122577OtherHEALTHLINK
IL371067092003OtherPRUDENTIAL