Provider Demographics
NPI:1912175100
Name:BARRY M LITTLEJOHN M.D. S.C.
Entity Type:Organization
Organization Name:BARRY M LITTLEJOHN M.D. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:MEADE
Authorized Official - Last Name:LITTLEJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-566-2004
Mailing Address - Street 1:6525 W SACK DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7104
Mailing Address - Country:US
Mailing Address - Phone:623-566-2004
Mailing Address - Fax:
Practice Address - Street 1:6525 W SACK DR
Practice Address - Street 2:SUITE 208
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7104
Practice Address - Country:US
Practice Address - Phone:623-566-2004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37577207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC51605Medicare UPIN
IL973910Medicare PIN