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General NPI Number Information
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NPI Number | 1376337337
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Entity Type | Individual
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Provider Name | VISHAL BOBBA MD
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Gender | Male
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 07/13/2025
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Provider Practice Location Address
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Address Line | 4220 W 95TH ST STE 200
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City | OAK LAWN
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State | IL
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Zip | 60453-3072
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Country | US
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Telephone | 708-398-0287
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Fax | 708-684-0281
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Provider Business Mailing Address
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Address Line | 510 W ERIE ST APT 1605
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City | CHICAGO
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State | IL
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Zip | 60654-6424
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Country | US
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Telephone | 309-798-6672
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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 | 125.086849
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License Number State | IL
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