MEDICARE: BHARAT K KOTADIA MD LLC

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	2080P0203X	Pediatric Critical Care Medicine Physician	036094599	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02234036	OTHER	IL	BC/BS OF ILLINOIS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033383120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BHARAT K KOTADIA MD LLC

Provider Business Mailing Address
First Line	:	1822 ARLINGTON LN
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-1309
Country	:	US
Telephone Number	:	630-871-7265
Fax Number	:	630-682-3353

Provider Business Practice Location Address
First Line	:	1822 ARLINGTON LN
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-1309
Country	:	US
Telephone Number	:	630-871-7265
Fax Number	:	630-682-3353

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BHARAT K KOTADIA
Credential	:	MD
Telephone Number	:	630-871-7265

Provider Enumeration Date	:	04/18/2008
Last Update Date	:	06/30/2009

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