Healthcare Provider Details

I. General information

NPI: 1518587344
Provider Name (Legal Business Name): NISARG BAKSHI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 COMPASS RD STE 100
GLENVIEW IL
60026-8042
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-6686
US

V. Phone/Fax

Practice location:
  • Phone: 847-729-6445
  • Fax: 847-729-9707
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-165710
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: