Provider Demographics
NPI:1477703189
Name:BISHU, SHREENATH (MD)
Entity Type:Individual
Prefix:
First Name:SHREENATH
Middle Name:
Last Name:BISHU
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 1:1000 N WESTMORELAND RD APT 3704
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1658
Mailing Address - Country:US
Mailing Address - Phone:847-535-6218
Mailing Address - Fax:847-535-6237
Practice Address - Street 1:1000 N WESTMORELAND RD APT 3704
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1658
Practice Address - Country:US
Practice Address - Phone:847-535-6218
Practice Address - Fax:847-535-6237
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-048944207ZP0102X
VA0116021240390200000X
IL036122363207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program