Provider Demographics
NPI:1053344903
Name:BARTEAU, JEFFREY ANDREW (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ANDREW
Last Name:BARTEAU
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 1:5668 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2464
Mailing Address - Country:US
Mailing Address - Phone:815-229-7580
Mailing Address - Fax:815-229-7585
Practice Address - Street 1:5668 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2464
Practice Address - Country:US
Practice Address - Phone:815-229-7580
Practice Address - Fax:815-229-7585
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088557208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088557Medicaid
020022267OtherRAILROAD MEDICARE
WI32030200Medicaid
F81206Medicare UPIN
020022267OtherRAILROAD MEDICARE