Provider Demographics
NPI:1396756748
Name:BARBER, ANGELA (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BARBER
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 1:1300 NORTH MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286
Mailing Address - Country:US
Mailing Address - Phone:618-443-4138
Mailing Address - Fax:618-443-3327
Practice Address - Street 1:1300 NORTH MARKET STREET
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286
Practice Address - Country:US
Practice Address - Phone:618-443-4138
Practice Address - Fax:618-443-3327
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03608509207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085059Medicaid
ILCH0349OtherRAILROAD MEDICARE
IL036085059Medicaid
F44961Medicare UPIN