Healthcare Provider Details

I. General information

NPI: 1255597167
Provider Name (Legal Business Name): DR. AMIT BHATE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HEALTH SERVICES DR STE 2
DEKALB IL
60115-9637
US

IV. Provider business mailing address

700 COMMERCE DR STE 500
OAK BROOK IL
60523-8736
US

V. Phone/Fax

Practice location:
  • Phone: 815-756-5255
  • Fax:
Mailing address:
  • Phone: 847-698-0600
  • Fax: 847-698-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036116681
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: