Provider Demographics
NPI:1356581441
Name:BART, ALEX JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:JOHN
Last Name:BART
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 1:14 S ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2371
Mailing Address - Country:US
Mailing Address - Phone:708-579-3451
Mailing Address - Fax:
Practice Address - Street 1:14 S. ASHLAND AVE.
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2371
Practice Address - Country:US
Practice Address - Phone:708-579-3451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.045519207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology