Provider Demographics
NPI:1457652950
Name:MOTILAL A BHATIA MD SC
Entity Type:Organization
Organization Name:MOTILAL A BHATIA MD SC
Other - Org Name:MOTILAL A BHATIA MD SC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOTIAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BHATIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-957-4011
Mailing Address - Street 1:17850 KEDZIE AVE STE 2100
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2056
Mailing Address - Country:US
Mailing Address - Phone:708-957-4011
Mailing Address - Fax:708-957-4013
Practice Address - Street 1:17850 KEDZIE AVE STE 2100
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2056
Practice Address - Country:US
Practice Address - Phone:708-957-4011
Practice Address - Fax:708-957-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062322207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty