Provider Demographics
NPI:1730495441
Name:BHABAD, SUDEEP HARI
Entity Type:Individual
Prefix:DR
First Name:SUDEEP
Middle Name:HARI
Last Name:BHABAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 E 13TH ST APT 2001
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3259
Mailing Address - Country:US
Mailing Address - Phone:312-813-2493
Mailing Address - Fax:
Practice Address - Street 1:1653 W CONGRESS PKWY # 181
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:312-942-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125057586174400000X
IL0361307892085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No174400000XOther Service ProvidersSpecialist