Healthcare Provider Details

I. General information

NPI: 1407929797
Provider Name (Legal Business Name): SWATI SUYOG BHOBE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 N RAND RD
PALATINE IL
60074-2919
US

IV. Provider business mailing address

1585 N RAND RD
PALATINE IL
60074-2919
US

V. Phone/Fax

Practice location:
  • Phone: 847-934-7969
  • Fax: 847-934-9243
Mailing address:
  • Phone: 847-934-9153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036099191
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: