Provider Demographics
NPI:1639894496
Name:BHIDE, MADHULI (MS)
Entity Type:Individual
Prefix:
First Name:MADHULI
Middle Name:
Last Name:BHIDE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MADHULI
Other - Middle Name:
Other - Last Name:BHAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS, MDS
Mailing Address - Street 1:1414 NOTTINGHAM LN APT 106H
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-4354
Mailing Address - Country:US
Mailing Address - Phone:920-939-0104
Mailing Address - Fax:
Practice Address - Street 1:23 W ROLLINS RD
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073-1350
Practice Address - Country:US
Practice Address - Phone:847-740-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0339341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice