MEDICARE: ANITA RANI BHARDWAJ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	C1-0026788	DE
2	207Q00000X	Family Medicine Physician	125.052953	IL

General Provider Information

NPI Number	:	1023264819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA RANI BHARDWAJ MD

Provider Business Mailing Address
First Line	:	2540 N IL ROUTE 83
Second Line	:
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073-4905
Country	:	US
Telephone Number	:	847-356-2752
Fax Number	:	847-356-2763

Provider Business Practice Location Address
First Line	:	2540 N IL ROUTE 83
Second Line	:
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073-4905
Country	:	US
Telephone Number	:	847-356-2752
Fax Number	:	847-356-2763

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	09/17/2024

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