Healthcare Provider Details

I. General information

NPI: 1255005351
Provider Name (Legal Business Name): JENNA BHATT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNA BHATT

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 BLACKHAWK DR
WESTMONT IL
60559-1115
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-3611
US

V. Phone/Fax

Practice location:
  • Phone: 630-963-5440
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085008681
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: