Healthcare Provider Details

I. General information

NPI: 1154510311
Provider Name (Legal Business Name): BALJINDER SINGH BATHLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S INDIANA AVE SUITE 100
CHICAGO IL
60605-2857
US

IV. Provider business mailing address

1550 S INDIANA AVE SUITE 100
CHICAGO IL
60605-2857
US

V. Phone/Fax

Practice location:
  • Phone: 312-623-7246
  • Fax: 312-583-9300
Mailing address:
  • Phone: 312-623-7246
  • Fax: 312-583-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number036116037
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number036116037
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: