MEDICARE: DR. PANTILA VANICHAKARN BATEMAN 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	207R00000X	Internal Medicine Physician	226001	MA
2	207RC0000X	Cardiovascular Disease Physician	15273	NH
3	207RC0000X	Cardiovascular Disease Physician	01075398A	IN
4	207RC0000X	Cardiovascular Disease Physician	036161785	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699940361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PANTILA VANICHAKARN BATEMAN M.D.

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-4959
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 SURRYSE RD STE 100
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-3217
Country	:	US
Telephone Number	:	815-206-5700
Fax Number	:	847-382-1771

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

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	09/09/2024

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Directions to “ DR. PANTILA VANICHAKARN BATEMAN M.D.” Practice Location

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