Provider Demographics
NPI:1063608974
Name:BARRY SADEGI, M.D., S.C.
Entity type:Organization
Organization Name:BARRY SADEGI, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OB-GYN
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SADEGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-434-9300
Mailing Address - Street 1:3825 HIGHLAND AVE STE 3B
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1549
Mailing Address - Country:US
Mailing Address - Phone:630-434-9300
Mailing Address - Fax:630-434-9302
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:3B
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1549
Practice Address - Country:US
Practice Address - Phone:630-434-9300
Practice Address - Fax:630-434-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046311207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046311Medicaid