Provider Demographics
NPI:1932194834
Name:SLOTKY, BARRY (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:SLOTKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N REGENCY DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3515
Mailing Address - Country:US
Mailing Address - Phone:309-663-6338
Mailing Address - Fax:309-661-5644
Practice Address - Street 1:107 N REGENCY DR
Practice Address - Street 2:SUITE 3
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3515
Practice Address - Country:US
Practice Address - Phone:309-663-6338
Practice Address - Fax:309-661-5644
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047218207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
833120OtherMEDICARE GROUP #
IL036047218Medicaid
IL036047218Medicaid
833120OtherMEDICARE GROUP #
IL569390Medicare ID - Type Unspecified