Healthcare Provider Details

I. General information

NPI: 1811217391
Provider Name (Legal Business Name): BHARAT PAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 OGDEN AVE SUITE 325
AURORA IL
60504-5894
US

IV. Provider business mailing address

185 HOLMES PL
MONTGOMERY IL
60538-1074
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-4850
  • Fax:
Mailing address:
  • Phone: 630-301-7453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125058268
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: