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NPI Code Detail

MEDICARE: MARUTI BHORADE, M.D.

MEDICARE: MARUTI BHORADE, 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
1207RN0300XNephrology PhysicianIL

General Provider Information

NPI Number : 1801895263
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARUTI BHORADE, M.D.
Provider Business Mailing Address
First Line : 520 E 22ND ST
Second Line :
City : LOMBARD
State : IL
Zip : 60148-6110
Country : US
Telephone Number : 630-874-2542
Fax Number : 630-874-2642
Provider Business Practice Location Address
First Line : 2233 W DIVISION ST
Second Line :
City : CHICAGO
State : IL
Zip : 60622-3043
Country : US
Telephone Number : 630-770-2172
Fax Number :
Authorized Official
Title or Position : BUSINESS MANAGER
Name : KATHRYN J CANNY
Credential :
Telephone Number : 630-960-9222
Provider Enumeration Date : 07/19/2005
Last Update Date : 07/21/2022

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