Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 036061994 | IL |
NPI | 1043291818 |
---|---|
Provider Name | Dr. Bashi Bandari |
First Address | Melrose Park, IL 60160-4138 |
Second Address | Melrose Park, IL 60160-4138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 11/09/2013 |