| Doctor Name: | DR. MOHAN PHATAK |
| NPI Number: | 1003841651 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | |
| Business Practice Address: | 7435 W Talcott Ave Chicago, IL - 606313707 |
| Business Phone Number: | 7737925138 |
| Business Fax Number: | 7737925124 |
| Mailing Address: | Po Box 68, NORTHBROOK |
| State: | IL |
| Postal Code: | 600650068 |
| Phone Number: | 8474129213 |
| Fax Number: | 8474129381 |
| NPI Enumeration Date: | 07/12/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085B0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Body Imaging |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |