Provider Demographics
NPI:1083634570
Name:BHAYANI, BIPINCHANDRA N (MD)
Entity Type:Individual
Prefix:
First Name:BIPINCHANDRA
Middle Name:N
Last Name:BHAYANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BIPIN
Other - Middle Name:
Other - Last Name:BHAYANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:455 W COURT ST
Mailing Address - Street 2:SUITE #403
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3679
Mailing Address - Country:US
Mailing Address - Phone:815-939-3190
Mailing Address - Fax:815-935-5101
Practice Address - Street 1:455 W COURT ST
Practice Address - Street 2:SUITE #403
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3679
Practice Address - Country:US
Practice Address - Phone:815-939-3190
Practice Address - Fax:815-935-5101
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059337A208800000X
IL036044204208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036044204Medicaid
ILC38599Medicare UPIN