Provider Demographics
NPI:1003034927
Name:BHATIA, SANDEEP K (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:K
Last Name:BHATIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 E. 13TH ST.
Mailing Address - Street 2:APT. 2208
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605
Mailing Address - Country:US
Mailing Address - Phone:312-399-6690
Mailing Address - Fax:
Practice Address - Street 1:20303 CRAWFORD AVE STE LL1
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1173
Practice Address - Country:US
Practice Address - Phone:708-898-1858
Practice Address - Fax:708-898-1860
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2060-850207W00000X
IL036126605207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036126605Medicaid