Healthcare Provider Details

I. General information

NPI: 1619955531
Provider Name (Legal Business Name): JAYANT BHALERAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9011 S COMMERCIAL AVE
CHICAGO IL
60617
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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: