Provider Demographics
NPI:1902035777
Name:BHATEJA, MANIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:MANIKA
Middle Name:
Last Name:BHATEJA
Suffix:
Gender:F
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:PO BOX 78866
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53278-8866
Mailing Address - Country:US
Mailing Address - Phone:776-696-7150
Mailing Address - Fax:
Practice Address - Street 1:18580 JOPLIN AVE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-4218
Practice Address - Country:US
Practice Address - Phone:952-892-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094895208000000X
IL036-130722208000000X
MN70561208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036130722Medicaid
IL036130722OtherIL PHYSICIAN LICENSE
IL070OtherTRICARE
ILFB3340508OtherDEA
IL036130722OtherIL PHYSICIAN LICENSE