Provider Demographics
NPI:1568649382
Name:BHARGAVA, NIKHIL (DO)
Entity Type:Individual
Prefix:DR
First Name:NIKHIL
Middle Name:
Last Name:BHARGAVA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 N CONVENT ST
Mailing Address - Street 2:STE. 1
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1081
Mailing Address - Country:US
Mailing Address - Phone:815-937-5200
Mailing Address - Fax:815-937-2063
Practice Address - Street 1:1615 N CONVENT ST
Practice Address - Street 2:STE. 1
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1081
Practice Address - Country:US
Practice Address - Phone:815-937-5200
Practice Address - Fax:815-937-2063
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119634207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036119634Medicaid
IL036119634Medicaid