Healthcare Provider Details

I. General information

NPI: 1134233950
Provider Name (Legal Business Name): BHARAT S JAILWALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

846 DUNDEE AVE
ELGIN IL
60120-3068
US

IV. Provider business mailing address

846 DUNDEE AVENUE
ELGIN IL
60120-3068
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-3555
  • Fax: 847-695-5937
Mailing address:
  • Phone: 847-695-3555
  • Fax: 847-695-5937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number036066206
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036066206
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: