1922035195 NPI number — DR. BARBARA IRENA SASIK MD

Table of content: DR. BARBARA IRENA SASIK MD (NPI 1922035195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922035195 NPI number — DR. BARBARA IRENA SASIK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SASIK
Provider First Name:
BARBARA
Provider Middle Name:
IRENA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SASIK
Provider Other First Name:
BARBARA
Provider Other Middle Name:
IRENA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1922035195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 E IRVING PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOOD DALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-616-9461
Provider Business Mailing Address Fax Number:
630-616-9467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 E IRVING PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOOD DALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-616-9461
Provider Business Practice Location Address Fax Number:
630-616-9467
Provider Enumeration Date:
06/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  036-085700 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036085700 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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