MEDICARE: DR. BHARAT K KOTADIA M.D.

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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02222589	OTHER	IL	BLUE CORSS/BLUE SHIELD IL

General Provider Information

NPI Number	:	1386659415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BHARAT K KOTADIA M.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	12/20/2007

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