MEDICARE: MANISH D BRAHMBHATT 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	207R00000X	Internal Medicine Physician	036-087405	IL

General Provider Information

NPI Number	:	1134153422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANISH D BRAHMBHATT MD

Provider Business Mailing Address
First Line	:	1740 W WHISPERING CT
Second Line	:
City	:	ADDISON
State	:	IL
Zip	:	60101-1864
Country	:	US
Telephone Number	:	847-372-8686
Fax Number	:	312-864-6350

Provider Business Practice Location Address
First Line	:	1901 W. HARRISON ST.
Second Line	:	JOHN H STROGER, JR HOSPITAL OF COOK COUNTY
City	:	CHICAGO
State	:	IL
Zip	:	60612
Country	:	US
Telephone Number	:	312-864-6343
Fax Number	:	312-864-6350

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	04/22/2021

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