1487732103 NPI number — DR. NITIN P BHOSALE MD

Table of content: DR. NITIN P BHOSALE MD (NPI 1487732103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487732103 NPI number — DR. NITIN P BHOSALE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BHOSALE
Provider First Name:
NITIN
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487732103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1408 ENGLISH OAK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAMPAIGN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61822-3351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-766-5170
Provider Business Mailing Address Fax Number:
888-665-3016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 N CLARENDON CT STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVOY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61874-6053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-683-6109
Provider Business Practice Location Address Fax Number:
888-665-3016
Provider Enumeration Date:
11/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083C0008X , with the licence number:  036118155 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0015X , with the licence number: 036118155 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 036118155 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)