Healthcare Provider Details

I. General information

NPI: 1093858953
Provider Name (Legal Business Name): VIRENDRA S. BISLA, MD, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9011 S COMMERCIAL AVE
CHICAGO IL
60617-4304
US

IV. Provider business mailing address

541 OTIS BOWEN DR
MUNSTER IN
46321-4158
US

V. Phone/Fax

Practice location:
  • Phone: 773-933-0700
  • Fax:
Mailing address:
  • Phone: 219-934-5300
  • Fax: 219-934-5389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: VIRENDRA BISLA
Title or Position: PRESIDENT
Credential: MD
Phone: 773-933-0700