Provider Demographics
NPI:1811098783
Name:NETTEM, BHARGAVI (MD)
Entity type:Individual
Prefix:
First Name:BHARGAVI
Middle Name:
Last Name:NETTEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BHARGAVI
Other - Middle Name:
Other - Last Name:ALAPARTHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:STE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7241
Mailing Address - Country:US
Mailing Address - Phone:317-865-8540
Mailing Address - Fax:317-865-8317
Practice Address - Street 1:3641 E 108TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-6951
Practice Address - Country:US
Practice Address - Phone:773-731-5466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36103788Medicaid
ILK33654Medicare PIN
ILH47517Medicare UPIN