Provider Demographics
NPI:1285154773
Name:BARTLETT, DEIRDRE MCCOLGAN (MD)
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:MCCOLGAN
Last Name:BARTLETT
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 1:225 E CHICAGO AVE BOX #37
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-227-6160
Mailing Address - Fax:312-227-9405
Practice Address - Street 1:225 E CHICAGO AVE BOX #37
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-227-6160
Practice Address - Fax:312-227-9405
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301112357208000000X
IL036156792208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics