Provider Demographics
NPI:1518925080
Name:COCA, BHAVANI L (MD)
Entity Type:Individual
Prefix:DR
First Name:BHAVANI
Middle Name:L
Last Name:COCA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 N WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1237
Mailing Address - Country:US
Mailing Address - Phone:847-541-9607
Mailing Address - Fax:
Practice Address - Street 1:396 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-1435
Practice Address - Country:US
Practice Address - Phone:847-432-7830
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK13599Medicare ID - Type UnspecifiedCOOK COUNTY
ILI23314Medicare UPIN
ILK13600Medicare ID - Type UnspecifiedFOR LAKE COUNTY