Provider Demographics
NPI:1942243472
Name:MALHOTRA, BIKRAMJIT (MD)
Entity Type:Individual
Prefix:DR
First Name:BIKRAMJIT
Middle Name:
Last Name:MALHOTRA
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 1:707 N LOGAN AVE
Mailing Address - Street 2:DANVILLE POLYCLINIC, LTD.
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-4360
Mailing Address - Country:US
Mailing Address - Phone:217-477-4784
Mailing Address - Fax:217-477-4704
Practice Address - Street 1:707 N LOGAN AVE
Practice Address - Street 2:DANVILLE POLYCLINIC, LTD.
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-4360
Practice Address - Country:US
Practice Address - Phone:217-477-4784
Practice Address - Fax:217-477-4704
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054354207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054354Medicaid
IN100026090AMedicaid
170582OtherPERSONAL CARE/COVENTRY
1676833OtherUNITED HEALTHCARE
IN110178213Medicare ID - Type UnspecifiedIN RAILROAD MEDICARE
1676833OtherUNITED HEALTHCARE
IN250890Medicare ID - Type UnspecifiedINDIANA MEDICARE
IN100026090AMedicaid
IL241540Medicare ID - Type UnspecifiedILLINOIS MEDICARE