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General NPI Number Information
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NPI Number | 1396815825
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Entity Type | Individual
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Provider Name | NAYANA UDAY PHATAK M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 05/14/2009
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Provider Practice Location Address
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Address Line | 2024 WEST. 79TH STREET
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City | CHICAGO
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State | IL
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Zip | 60620
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Country | US
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Telephone | 773-859-1114
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Fax |
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Provider Business Mailing Address
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Address Line | 3541 S. EUCLID AVENUE UNIT #3
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City | BERWYN
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State | IL
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Zip | 60402
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Country | US
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Telephone | 708-484-5462
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036060828
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License Number State | IL
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