Healthcare Provider Details

I. General information

NPI: 1629064621
Provider Name (Legal Business Name): DHARMASHI VISHANJI BHATE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 HILLCREST CT
MENDOTA IL
61342-1008
US

IV. Provider business mailing address

1718 HILLCREST CT
MENDOTA IL
61342-1008
US

V. Phone/Fax

Practice location:
  • Phone: 815-538-2717
  • Fax: 815-756-4046
Mailing address:
  • Phone: 815-538-2717
  • Fax: 815-756-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: