Provider Demographics
NPI:1265548093
Name:BATHINA, KRISHNA SARADA (MD)
Entity type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:SARADA
Last Name:BATHINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISHNA
Other - Middle Name:SARADA
Other - Last Name:ALLAMSETTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1860 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0018
Mailing Address - Country:US
Mailing Address - Phone:630-942-7998
Mailing Address - Fax:
Practice Address - Street 1:608 S WASHINGTON ST STE 201
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6661
Practice Address - Country:US
Practice Address - Phone:630-717-2630
Practice Address - Fax:630-355-9546
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108950Medicaid
IL208909Medicare ID - Type Unspecified