Provider Demographics
NPI:1750585089
Name:BHATT, OMPRAKASH M (MD)
Entity type:Individual
Prefix:DR
First Name:OMPRAKASH
Middle Name:M
Last Name:BHATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 4931
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4931
Mailing Address - Country:US
Mailing Address - Phone:866-540-5303
Mailing Address - Fax:
Practice Address - Street 1:501 S 54TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1900
Practice Address - Country:US
Practice Address - Phone:866-344-0543
Practice Address - Fax:866-344-3934
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235721207RC0200X
PAMD068893L207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30043786OtherKEYSTONE MERCY
PA1972038OtherHIGHMARK
PA2881745000OtherBLUE SHIELD INDEPENDENCE
PA1019395490001Medicaid
PA2881745000OtherBLUE SHIELD INDEPENDENCE
PA30043786OtherKEYSTONE MERCY
H24663Medicare UPIN