Provider Demographics
NPI:1750310553
Name:BOBAT, ISMAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ISMAIL
Middle Name:
Last Name:BOBAT
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 1:5300 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-5300
Mailing Address - Country:US
Mailing Address - Phone:708-633-1234
Mailing Address - Fax:708-342-7272
Practice Address - Street 1:1400 WEST PARK ST
Practice Address - Street 2:SUITE D2248
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2396
Practice Address - Country:US
Practice Address - Phone:217-337-3738
Practice Address - Fax:217-337-4569
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-110991207RS0012X, 207RC0200X
IL036110991207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCA2264OtherRR GROUP
IL036110991OtherILLINOIS MEDICAL LICENSE
IL036110991Medicaid
IL833120OtherMEDICARE GROUP #
IA35437OtherIOWA MEDICAL LICENSE
MI4301078417OtherMICHIGAN MEDICAL LICENSE
ILP00446526OtherRR INDIVIDUAL
ILP00446526OtherRR INDIVIDUAL