Healthcare Provider Details

I. General information

NPI: 1780670596
Provider Name (Legal Business Name): SUMIT BHATIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 JACOBSSEN DR STE C
NORMAL IL
61761-6280
US

IV. Provider business mailing address

2010 JACOBSSEN DR STE C
NORMAL IL
61761-6280
US

V. Phone/Fax

Practice location:
  • Phone: 815-390-7271
  • Fax:
Mailing address:
  • Phone: 815-390-7271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number036117968
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number223699
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: