Provider Demographics
NPI:1649463282
Name:PANDIT, BELA (PC)
Entity type:Individual
Prefix:
First Name:BELA
Middle Name:
Last Name:PANDIT
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 W 95TH ST
Mailing Address - Street 2:STE 104
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2004
Mailing Address - Country:US
Mailing Address - Phone:312-523-4584
Mailing Address - Fax:720-834-9073
Practice Address - Street 1:3830 W 95TH ST STE 104
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2004
Practice Address - Country:US
Practice Address - Phone:708-423-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005203213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01635520OtherBCBS
IL5617590001OtherPTAN
IL016005203Medicaid
ILP00338399OtherRAIL ROAD MEDICARE
IL016005203Medicaid
ILK21890Medicare PIN