1265548093 NPI number — DR. KRISHNA SARADA BATHINA MD

Table of content: DR. KRISHNA SARADA BATHINA MD (NPI 1265548093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265548093 NPI number — DR. KRISHNA SARADA BATHINA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BATHINA
Provider First Name:
KRISHNA
Provider Middle Name:
SARADA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALLAMSETTY
Provider Other First Name:
KRISHNA
Provider Other Middle Name:
SARADA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265548093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1860 PAYSPHERE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60674-0018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-942-7998
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
608 S WASHINGTON ST STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60540-6661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-717-2630
Provider Business Practice Location Address Fax Number:
630-355-9546
Provider Enumeration Date:
08/22/2006

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: 207R00000X , with the licence number:  036108950 , 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)

  • Identifier: 036108950 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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