MEDICARE: BHAVANA P VAIDYA 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	208100000X	Physical Medicine & Rehabilitation Physician	036066303	IL
2	208D00000X	General Practice Physician	036066303	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11871240	OTHER	IL	CAQH
2	711960	OTHER	IL	PTAN
3	316009776	OTHER	IL	BC
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437141108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BHAVANA P VAIDYA MD

Provider Business Mailing Address
First Line	:	10601 S KILBOURN AVE
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-5341
Country	:	US
Telephone Number	:	708-425-2516
Fax Number	:

Provider Business Practice Location Address
First Line	:	6307 S STEWART AVE STE 201
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-3116
Country	:	US
Telephone Number	:	773-962-4025
Fax Number	:

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	03/07/2023

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Directions to “ BHAVANA P VAIDYA MD” Practice Location

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