Healthcare Provider Details

I. General information

NPI: 1356109227
Provider Name (Legal Business Name): AT URGENT CARE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17577 KEDZIE AVE
HAZEL CREST IL
60429-2051
US

IV. Provider business mailing address

400 ARBOR DR
LAKE BLUFF IL
60044-1350
US

V. Phone/Fax

Practice location:
  • Phone: 847-920-8181
  • Fax:
Mailing address:
  • Phone: 708-312-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: VIKAS BHATARA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 708-321-0533