Provider Demographics
NPI:1043222474
Name:SAMY, BHARATHI (MD)
Entity Type:Individual
Prefix:
First Name:BHARATHI
Middle Name:
Last Name:SAMY
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 1:4025 N WESTERN AVE
Mailing Address - Street 2:BLDG E.
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3726
Mailing Address - Country:US
Mailing Address - Phone:773-275-7700
Mailing Address - Fax:
Practice Address - Street 1:4025 N WESTERN AVE
Practice Address - Street 2:BLDG E.
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3726
Practice Address - Country:US
Practice Address - Phone:773-275-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-073049207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF91644Medicare UPIN