Provider Demographics
NPI:1295746824
Name:BAKANE, HEMLATA D (MD)
Entity type:Individual
Prefix:DR
First Name:HEMLATA
Middle Name:D
Last Name:BAKANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12755 W QUAILS ROOST DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3754
Mailing Address - Country:US
Mailing Address - Phone:815-462-1706
Mailing Address - Fax:816-462-3029
Practice Address - Street 1:12755 QUAILS ROOST DR
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2795
Practice Address - Country:US
Practice Address - Phone:815-462-1706
Practice Address - Fax:816-462-3029
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-086641207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086641Medicaid
IL036086641Medicaid
IL336531Medicare ID - Type Unspecified