Provider Demographics
NPI:1962668137
Name:UPTOWN MEDICAL CENTER INC
Entity Type:Organization
Organization Name:UPTOWN MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CLINIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYANT
Authorized Official - Middle Name:C
Authorized Official - Last Name:BHALERAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:733-257-1880
Mailing Address - Street 1:4527 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5608
Mailing Address - Country:US
Mailing Address - Phone:773-275-1880
Mailing Address - Fax:
Practice Address - Street 1:4527 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5608
Practice Address - Country:US
Practice Address - Phone:773-275-1880
Practice Address - Fax:773-275-1813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046837207Q00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty