Healthcare Provider Details

I. General information

NPI: 1356281653
Provider Name (Legal Business Name): NISHESH BATRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 W 14TH ST
CHICAGO HEIGHTS IL
60411-2386
US

IV. Provider business mailing address

1242 PLATO DRIVE
FORT ERIE ONTARIO
L2A0C7
CA

V. Phone/Fax

Practice location:
  • Phone: 708-283-9800
  • Fax: 708-283-9801
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019037179
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: