Gastwirth, Bart Wayne
Gastwirth, Bart Wayne is an sole proprietor health care provider with primary practice located at 1802 S Mattis Ave , Champaign IL 61821-5923. He recently has 5 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine, Podiatric Medicine & Surgery Service Providers / Foot Surgery, Podiatric Medicine & Surgery Service Providers / Sports Medicine, Podiatric Medicine & Surgery Service Providers / Radiology, Podiatric Medicine & Surgery Service Providers / Podiatrist. Podiatric Medicine & Surgery Service Providers / Foot Surgery is his primary health care specialty. Gastwirth, Bart Wayne can be contacted via phone (217) 383-3260.Contact Information
Primary practice address
1802 S Mattis Ave
Champaign IL 61821-5923
Phone: (217) 383-3260
Fax: (217) 383-4459
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine | 213EP1101X | 016-002956 | Illinois |
| Podiatric Medicine & Surgery Service Providers / Foot Surgery | 213ES0131X | 016-002956 | Illinois |
| Podiatric Medicine & Surgery Service Providers / Sports Medicine | 213ES0000X | 016-0002956 | Illinois |
| Podiatric Medicine & Surgery Service Providers / Radiology | 213ER0200X | 016-002956 | Illinois |
| Podiatric Medicine & Surgery Service Providers / Podiatrist | 213E00000X | 016-0002956 | Illinois |
Profile Details
| NPI number | 1568459030 |
|---|---|
| LBN Legal business name | Gastwirth, Bart Wayne |
| Credentials | Doctor of Podiatric Medicine (DPM) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 30th, 2005 |
| Last updated | Oct 18th, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568459030 | NPPES |
| Illinois | Other | 60001121 | BLUE CROSS BLUE SHIELD |
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