Healthcare Provider Details

I. General information

NPI: 1588921035
Provider Name (Legal Business Name): NATASHA BHAYANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATASHA RAJABALI

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 S PROMONTORY DR
CHICAGO IL
60649-1003
US

IV. Provider business mailing address

77 E 16TH ST UNIT 4
CHICAGO IL
60616-5519
US

V. Phone/Fax

Practice location:
  • Phone: 773-753-8638
  • Fax: 773-363-7143
Mailing address:
  • Phone: 630-890-7413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036140294
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: