Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0101X | MOHS-Micrographic Surgeon | 036111397 | IL |
Y | 207NS0135X | Procedural Dermatology | 036111397 | IL |
NPI | 1073595690 |
---|---|
Provider Name | Ashish C Bhatia |
First Address | Itasca, IL 60143-2639 |
Second Address | Itasca, IL 60143-2639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 11/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00174102 | RR MEDICARE (01) | IL |