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NPI Code Detail

MEDICARE: SATISH BASTOLA MD

MEDICARE: SATISH BASTOLA 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
1207R00000XInternal Medicine Physician125.081774IL

General Provider Information

NPI Number : 1639858798
Entity Type Code : Individual
Provider Name (Legal Business Name) : SATISH BASTOLA MD
Provider Business Mailing Address
First Line : 2800 N LAKE SHORE DR APT 3111
Second Line :
City : CHICAGO
State : IL
Zip : 60657-6275
Country : US
Telephone Number : 773-837-0251
Fax Number :
Provider Business Practice Location Address
First Line : 2900 N LAKE SHORE DR
Second Line :
City : CHICAGO
State : IL
Zip : 60657-5640
Country : US
Telephone Number : 773-665-6730
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2023
Last Update Date : 05/14/2026

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Directions to “ SATISH BASTOLA MD” Practice Location

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