Provider Demographics
NPI:1093766420
Name:BHARGAVA, SITAL (DO)
Entity Type:Individual
Prefix:DR
First Name:SITAL
Middle Name:
Last Name:BHARGAVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SITAL
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:11801 LONDON BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1968
Mailing Address - Country:US
Mailing Address - Phone:815-277-9232
Mailing Address - Fax:815-410-4806
Practice Address - Street 1:11801 LONDON BRIDGE DR,
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-1968
Practice Address - Country:US
Practice Address - Phone:815-277-9232
Practice Address - Fax:815-410-4806
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I28473Medicare UPIN
0025168086Medicare ID - Type Unspecified