Healthcare Provider Details

I. General information

NPI: 1265458343
Provider Name (Legal Business Name): BHARTI N AMIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 LINCOLN HWY STE 101
MATTESON IL
60443-3802
US

IV. Provider business mailing address

4440 LINCOLN HWY STE 101
MATTESON IL
60443-3802
US

V. Phone/Fax

Practice location:
  • Phone: 708-748-5910
  • Fax: 708-748-5984
Mailing address:
  • Phone: 708-748-5910
  • Fax: 708-748-5984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036058749
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier036058749
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: