Healthcare Provider Details

I. General information

NPI: 1831553635
Provider Name (Legal Business Name): MILAP BHATT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 N CALIFORNIA AVE
CHICAGO IL
60625-3661
US

IV. Provider business mailing address

2124 W DIVISION ST APT 4
CHICAGO IL
60622-2985
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-3808
  • Fax:
Mailing address:
  • Phone: 630-310-6552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036148447
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: