Provider Demographics
NPI: | 1124447412 |
---|---|
Name: | ENCOUNTER MEDICAL GROUP, P.C. |
Entity type: | Organization |
Organization Name: | ENCOUNTER MEDICAL GROUP, P.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ANDREA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BARTHWELL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 708-613-4750 |
Mailing Address - Street 1: | 610 S MAPLE AVE |
Mailing Address - Street 2: | SUITE 3400 |
Mailing Address - City: | OAK PARK |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60304-1091 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 708-613-4750 |
Mailing Address - Fax: | 708-613-4754 |
Practice Address - Street 1: | 610 S MAPLE AVE |
Practice Address - Street 2: | SUITE 3400 |
Practice Address - City: | OAK PARK |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60304-1091 |
Practice Address - Country: | US |
Practice Address - Phone: | 708-613-4750 |
Practice Address - Fax: | 708-613-4754 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-04-15 |
Last Update Date: | 2014-04-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | A-4410-0002-A | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |