Provider Demographics
NPI:1265458343
Name:AMIN, BHARTI N (MD)
Entity Type:Individual
Prefix:
First Name:BHARTI
Middle Name:N
Last Name:AMIN
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 1:4440 LINCOLN HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-3802
Mailing Address - Country:US
Mailing Address - Phone:708-748-5910
Mailing Address - Fax:708-748-5984
Practice Address - Street 1:4440 LINCOLN HWY STE 101
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-3802
Practice Address - Country:US
Practice Address - Phone:708-748-5910
Practice Address - Fax:708-748-5984
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058749208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058749Medicaid
339290Medicare ID - Type Unspecified