Provider Demographics
NPI:1306806831
Name:BRYK-SERVA, DEBORAH ANN (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:BRYK-SERVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1405 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-5924
Mailing Address - Country:US
Mailing Address - Phone:847-884-1212
Mailing Address - Fax:847-884-1291
Practice Address - Street 1:1555 BARRINGTON RD
Practice Address - Street 2:#430
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60194-1018
Practice Address - Country:US
Practice Address - Phone:847-884-1212
Practice Address - Fax:847-884-1291
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC39262Medicare UPIN