Healthcare Provider Details

I. General information

NPI: 1033426705
Provider Name (Legal Business Name): BHARTI RAIZADA M.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 OAK PARK AVE
BERWYN IL
60402-3429
US

IV. Provider business mailing address

68 S. SERVICE RD SUITE 350
MELVILLE NY
11747-2358
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-6339
  • Fax:
Mailing address:
  • Phone: 516-945-3115
  • Fax: 516-945-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036124445
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036124445
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: