Provider Demographics
NPI:1275525495
Name:CHITTINENI, BHARATI (MD)
Entity Type:Individual
Prefix:DR
First Name:BHARATI
Middle Name:
Last Name:CHITTINENI
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 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:866-630-9882
Mailing Address - Fax:920-682-5810
Practice Address - Street 1:550 E BOUGHTON RD
Practice Address - Street 2:SUITE 170
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2100
Practice Address - Country:US
Practice Address - Phone:262-898-4400
Practice Address - Fax:630-739-3377
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-105923207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105923Medicaid