Healthcare Provider Details

I. General information

NPI: 1790943231
Provider Name (Legal Business Name): STEVEN JOHN BACHTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2008
Last Update Date: 04/27/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE. PEDIATRIC HOSPITALISTS
EVANSTON IL
60201-1718
US

IV. Provider business mailing address

2650 RIDGE AVE. PEDIATRIC HOSPITALISTS
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5000
  • Fax:
Mailing address:
  • Phone: 847-570-2833
  • Fax: 847-570-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125052666
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: