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General NPI Number Information
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NPI Number | 1114107422
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Entity Type | Organization
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Legal Business Name | BAKUL K. PANDYA, M.D.S.C.
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 75 129TH INFANTRY DR
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City | JOLIET
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State | IL
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Zip | 60435
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Country | US
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Telephone | 815-741-2301
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Fax | 815-741-2348
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Provider Business Mailing Address
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Address Line | 75 129TH INFANTRY DR
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City | JOLIET
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State | IL
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Zip | 60435-5134
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Country | US
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Telephone | 815-741-2301
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BAKUL K PANDYA
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Credential | M.D.
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Telephone | 815-741-2301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State | IL
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