Healthcare Provider Details

I. General information

NPI: 1619021920
Provider Name (Legal Business Name): BANI BHATTACHARYYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 N ARLINGTON HEIGHTS RD SUITE 110
ARLINGTON HEIGHTS IL
60004-3985
US

IV. Provider business mailing address

1640 N ARLINGTON HEIGHTS RD SUITE 110
ARLINGTON HEIGHTS IL
60004-3985
US

V. Phone/Fax

Practice location:
  • Phone: 847-255-7400
  • Fax: 847-398-4585
Mailing address:
  • Phone: 847-255-7400
  • Fax: 847-398-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: