Provider Demographics
NPI:1447309166
Name:BARR, MARY BETH (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:BARR
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 1:4719 83RD PL
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-2301
Mailing Address - Country:US
Mailing Address - Phone:262-942-0100
Mailing Address - Fax:
Practice Address - Street 1:3001A SIXTH ST.
Practice Address - Street 2:
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-5230
Practice Address - Country:US
Practice Address - Phone:847-688-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32966-022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology