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General NPI Number Information
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NPI Number | 1265965123
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Entity Type | Individual
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Provider Name | AMRIT V BHASKARLA D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 05/03/2024
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Provider Practice Location Address
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Address Line | 3001 GREEN BAY RD
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City | NORTH CHICAGO
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State | IL
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Zip | 60064-3048
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Country | US
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Telephone | 847-688-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 WATERVIEW DR UNIT 354
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City | NORTHBROOK
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State | IL
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Zip | 60062-6366
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Country | US
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Telephone | 815-483-0971
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | B264-0189-0225
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | 036153118
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 036153118
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 036153118
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License Number State | IL
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