Provider Demographics
NPI:1013177278
Name:VARSHA BHAN MD SC
Entity Type:Organization
Organization Name:VARSHA BHAN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-669-1630
Mailing Address - Street 1:17850 SOUTH KEDZIE AVE
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429
Mailing Address - Country:US
Mailing Address - Phone:708-669-1630
Mailing Address - Fax:708-799-2261
Practice Address - Street 1:17850 KEDZIE AVE
Practice Address - Street 2:SUITE 1700
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2058
Practice Address - Country:US
Practice Address - Phone:708-669-1630
Practice Address - Fax:708-799-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098405261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098405Medicaid
H17307Medicare UPIN