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General NPI Number Information
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NPI Number | 1811995426
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Entity Type | Individual
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Provider Name | SURESH BHALLA MD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 210 N HAMMES AVE SUITE 112
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City | JOLIET
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State | IL
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Zip | 60435-6680
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Country | US
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Telephone | 815-744-2054
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Fax | 815-744-5823
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Provider Business Mailing Address
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Address Line | 210 N HAMMES AVE SUITE 112
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City | JOLIET
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State | IL
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Zip | 60435-6680
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Country | US
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Telephone | 815-744-2054
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Fax | 815-744-5823
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 036062964
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036062964
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License Number State | IL
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