Provider Demographics
NPI:1629064621
Name:BHATE, DHARMASHI VISHANJI (MD)
Entity Type:Individual
Prefix:
First Name:DHARMASHI
Middle Name:VISHANJI
Last Name:BHATE
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 1:1718 HILLCREST CT
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-1008
Mailing Address - Country:US
Mailing Address - Phone:815-538-2717
Mailing Address - Fax:815-756-4046
Practice Address - Street 1:1718 HILLCREST CT
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:IL
Practice Address - Zip Code:61342-1008
Practice Address - Country:US
Practice Address - Phone:815-538-2717
Practice Address - Fax:815-756-4046
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C44803Medicare UPIN
251130Medicare ID - Type Unspecified