Healthcare Provider Details

I. General information

NPI: 1699063792
Provider Name (Legal Business Name): NEHA BHAGI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST
CHICAGO IL
60612-4795
US

IV. Provider business mailing address

26460 NETWORK PL
CHICAGO IL
60673-1264
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-1300
  • Fax:
Mailing address:
  • Phone: 773-257-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036135643
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: