Provider Demographics
NPI:1336105154
Name:SWAMINATHAN, BHARATHI (MD)
Entity Type:Individual
Prefix:DR
First Name:BHARATHI
Middle Name:
Last Name:SWAMINATHAN
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 1:1. S.GREENLEAF STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:847-918-1442
Mailing Address - Fax:847-327-3882
Practice Address - Street 1:1. S GREENLEAF ST
Practice Address - Street 2:STE D
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5709
Practice Address - Country:US
Practice Address - Phone:847-918-1442
Practice Address - Fax:847-327-3882
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107247208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107247Medicaid
IL036107247Medicaid
ILK20648Medicare ID - Type Unspecified