Healthcare Provider Details

I. General information

NPI: 1558415802
Provider Name (Legal Business Name): BHUVANESWARI VISWANATHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 NORTH LINCOLN AVE SUITE 27, DIVERSIFIED EMERGENCY SERVICES LLC
CHICAGO IL
60659
US

IV. Provider business mailing address

1107 COMPASS CT
NAPERVILLE IL
60540-8151
US

V. Phone/Fax

Practice location:
  • Phone: 773-728-5133
  • Fax: 773-728-5134
Mailing address:
  • Phone: 312-933-1241
  • Fax: 630-857-9315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36116586
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: