Provider Demographics
NPI:1417082827
Name:BHATT, KASHYAP S (MD)
Entity Type:Individual
Prefix:DR
First Name:KASHYAP
Middle Name:S
Last Name:BHATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-1637
Mailing Address - Country:US
Mailing Address - Phone:815-432-5747
Mailing Address - Fax:815-432-5747
Practice Address - Street 1:514 S 5TH ST
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1637
Practice Address - Country:US
Practice Address - Phone:815-432-5747
Practice Address - Fax:815-432-5747
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
003989OtherHEALTH ALLIANCE
IL03815089OtherBLUE CROSS BLUE SHIELD
ILB51550Medicare UPIN
954130Medicare ID - Type Unspecified