Provider Demographics
NPI:1417060146
Name:BATHINA, RAMESH (MD)
Entity Type:Individual
Prefix:
First Name:RAMESH
Middle Name:
Last Name:BATHINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1300 N HIGHLAND AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1464
Mailing Address - Country:US
Mailing Address - Phone:630-966-9999
Mailing Address - Fax:630-966-8919
Practice Address - Street 1:1315 N HIGHLAND AVE # 105
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1400
Practice Address - Country:US
Practice Address - Phone:630-966-9999
Practice Address - Fax:630-859-2378
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036107849208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG37264Medicare UPIN