Healthcare Provider Details

I. General information

NPI: 1811026446
Provider Name (Legal Business Name): VIKAS BHATARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ARBOR DR
LAKE BLUFF IL
60044-1350
US

IV. Provider business mailing address

400 ARBOR DR
LAKE BLUFF IL
60044-1350
US

V. Phone/Fax

Practice location:
  • Phone: 708-321-0533
  • Fax:
Mailing address:
  • Phone: 708-321-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number51245
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number51245
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036116058
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number036116058
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036116058
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: