Provider Demographics
NPI:1023223161
Name:BOBBA, KISHORE (MD)
Entity Type:Individual
Prefix:DR
First Name:KISHORE
Middle Name:
Last Name:BOBBA
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 1:1060 W HOLLYWOOD AVE
Mailing Address - Street 2:APT 406
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4506
Mailing Address - Country:US
Mailing Address - Phone:773-290-7870
Mailing Address - Fax:
Practice Address - Street 1:3800 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-2334
Practice Address - Country:US
Practice Address - Phone:773-826-6600
Practice Address - Fax:773-826-1407
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36117320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine