Provider Demographics
NPI:1346419827
Name:BHARATI CHITTINENI MD SC
Entity Type:Organization
Organization Name:BHARATI CHITTINENI MD SC
Other - Org Name:NAPERBROOK DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BHARATI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHITTINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-739-3376
Mailing Address - Street 1:6547 N AVONDALE AVE
Mailing Address - Street 2:SUITE 001
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1573
Mailing Address - Country:US
Mailing Address - Phone:773-775-1622
Mailing Address - Fax:
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:630-739-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105923207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105923Medicaid