Basic Information
Provider Information
NPI: 1568407641
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARAN
FirstName: EMILY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: GOREN
OtherFirstName: EMILY
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 680 N LAKE SHORE DR
Address2: SUITE 1000
City: CHICAGO
State: IL
PostalCode: 606114546
CountryCode: US
TelephoneNumber: 3126959797
FaxNumber:  
Practice Location
Address1: 680 N LAKE SHORE DR
Address2: SUITE 1000
City: CHICAGO
State: IL
PostalCode: 606114546
CountryCode: US
TelephoneNumber: 3126959797
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/20/2006
LastUpdateDate: 09/26/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X ILY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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