Organization Name: | BHAKTA MEDICAL ASSOCIATES |
NPI Number: | 1326266255 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHANDU D. BHAKTA (OWNER) |
Mailing Address: | 6283 S Archer Ave Chicago |
State: | IL US |
Postal Code: | 606382505 |
Phone Number: | 7735853131 |
Fax Number: | 7735854565 |
NPI Enumeration Date: | 04/23/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |