Healthcare Provider Details

I. General information

NPI: 1295175990
Provider Name (Legal Business Name): SARVOTTAM BAJAJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OGDEN AVE
AURORA IL
60504-7222
US

IV. Provider business mailing address

2000 OGDEN AVE
AURORA IL
60504-7222
US

V. Phone/Fax

Practice location:
  • Phone: 866-565-8607
  • Fax: 312-563-8661
Mailing address:
  • Phone: 866-565-8607
  • Fax: 312-563-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.064105
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036138699
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: