Provider Demographics
NPI:1891806246
Name:BHANDARKAR, MANOHAR SITARAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MANOHAR
Middle Name:SITARAM
Last Name:BHANDARKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1460 MARKET ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4643
Mailing Address - Country:US
Mailing Address - Phone:847-299-3353
Mailing Address - Fax:847-299-2137
Practice Address - Street 1:1460 MARKET ST
Practice Address - Street 2:SUITE 202
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4643
Practice Address - Country:US
Practice Address - Phone:847-299-3353
Practice Address - Fax:847-299-2137
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-058096207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058096Medicaid
IL036058096Medicaid
C43526Medicare UPIN