Provider Demographics
NPI:1245202068
Name:BAHU, AMIRA MARY (MD)
Entity Type:Individual
Prefix:
First Name:AMIRA
Middle Name:MARY
Last Name:BAHU
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 1:7435 W. TALCOTT AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-990-7684
Mailing Address - Fax:773-792-5124
Practice Address - Street 1:7435 W. TALCOTT AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-990-7684
Practice Address - Fax:773-792-5124
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1094602085R0202X
WI443682085R0202X
IN01059870A2085R0202X
IL0361094602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH66324Medicare UPIN
ILF400112429Medicare PIN
ILK06062Medicare PIN
ILK01872Medicare ID - Type UnspecifiedGRC COOK COUNTY
ILK22459Medicare ID - Type UnspecifiedGMI COOK COUNTY
ILH66324Medicare UPIN
ILK01276Medicare ID - Type UnspecifiedMIDWESTERN REGIONAL
ILK01736Medicare ID - Type UnspecifiedGRC LAKE COUNTY