Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 019-027796 | IL |
Y | 213EG0000X | General Practice | 019-027796 | IL |
NPI | 1003062464 |
---|---|
Provider Name | Cheitali Bhansali |
First Address | Glendale Heights, IL 60139-1916 |
Second Address | Oak Lawn, IL 60453-1001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2008 |
Last Update Date | 15/08/2008 |