Provider Demographics
NPI:1083759344
Name:BHALERAO, SACHIN JAYANT (DO)
Entity Type:Individual
Prefix:DR
First Name:SACHIN
Middle Name:JAYANT
Last Name:BHALERAO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 N MILL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2047
Mailing Address - Country:US
Mailing Address - Phone:630-646-8000
Mailing Address - Fax:630-646-8007
Practice Address - Street 1:1335 N MILL ST STE 100
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2047
Practice Address - Country:US
Practice Address - Phone:630-646-8000
Practice Address - Fax:630-646-8007
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010169642084P0800X
IL036-1272912084P0805X
IL0361272912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036127291Medicaid
ILT01748Medicare UPIN