Provider Demographics
NPI:1003098914
Name:BHATIA, NEELAM MOTILAL (MD)
Entity Type:Individual
Prefix:DR
First Name:NEELAM
Middle Name:MOTILAL
Last Name:BHATIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17680 KEDZIE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2043
Mailing Address - Country:US
Mailing Address - Phone:708-574-6814
Mailing Address - Fax:
Practice Address - Street 1:17680 KEDZIE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2043
Practice Address - Country:US
Practice Address - Phone:708-574-6814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL359170Medicare PIN
ILF95470Medicare UPIN