MEDICARE: DHARMASHI VISHANJI BHATE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician		IL

General Provider Information

NPI Number	:	1629064621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DHARMASHI VISHANJI BHATE MD

Provider Business Mailing Address
First Line	:	1718 HILLCREST CT
Second Line	:
City	:	MENDOTA
State	:	IL
Zip	:	61342-1008
Country	:	US
Telephone Number	:	815-538-2717
Fax Number	:	815-756-4046

Provider Business Practice Location Address
First Line	:	1718 HILLCREST CT
Second Line	:
City	:	MENDOTA
State	:	IL
Zip	:	61342-1008
Country	:	US
Telephone Number	:	815-538-2717
Fax Number	:	815-756-4046

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2005
Last Update Date	:	07/08/2007

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