Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036138298 | IL |
N | 111NI0900X | Internist | 036138298 | IL |
N | 207R00000X | Internist | 125061650 | IL |
N | 111NI0900X | Internist | 125061650 | IL |
N | 208000000X | Pediatrician | 036138298 | IL |
N | 208000000X | Pediatrician | 125061650 | IL |
NPI | 1003179912 |
---|---|
Provider Name | Ajay Bhasin |
First Address | Chicago, IL 60611-2908 |
Second Address | Chicago, IL 60611-2908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2012 |
Last Update Date | 25/05/2017 |