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General NPI Number Information
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NPI Number | 1154510311
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Entity Type | Individual
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Provider Name | BALJINDER SINGH BATHLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 1550 S INDIANA AVE SUITE 100
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City | CHICAGO
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State | IL
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Zip | 60605-2857
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Country | US
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Telephone | 312-623-7246
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Fax | 312-583-9300
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Provider Business Mailing Address
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Address Line | 1550 S INDIANA AVE SUITE 100
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City | CHICAGO
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State | IL
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Zip | 60605-2857
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Country | US
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Telephone | 312-623-7246
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Fax | 312-583-9300
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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 | 2081N0008X
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Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 036116037
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 036116037
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License Number State | IL
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