Individual
DR. CYNTHIA L BARTHOLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD PC
Contact information
Practice address
1921 LAKE AVE STE B, SUITE B, WILMETTE, IL 60091-1480
(847) 853-9100
(847) 853-9103
Mailing address
1921 LAKE AVE STE B, SUITE B, WILMETTE, IL 60091-1480
(847) 853-9100
(847) 853-9103
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036081882
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632720
BCBS
—
01
—
036081882
STATE LICENSE
IL
01
—
DS1615
MEDICARE RAILROAD GRP PTAN
IL
01
—
IL5671
MEDICARE PTAN
IL
Enumeration date
07/12/2006
Last updated
03/07/2023
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