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General NPI Number Information
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NPI Number | 1003841651
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Entity Type | Individual
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Provider Name | MOHAN PHATAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 7435 W TALCOTT AVE
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City | CHICAGO
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State | IL
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Zip | 60631-3707
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Country | US
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Telephone | 773-792-5138
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Fax | 773-792-5124
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Provider Business Mailing Address
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Address Line | PO BOX 68
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City | NORTHBROOK
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State | IL
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Zip | 60065-0068
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Country | US
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Telephone | 847-412-9213
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Fax | 847-412-9381
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number |
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number |
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State | IL
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