Provider Demographics
NPI:1053584227
Name:BHATT, JYOTSNA (MD)
Entity type:Individual
Prefix:
First Name:JYOTSNA
Middle Name:
Last Name:BHATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JYOTSNA
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 MADIDON STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4210
Mailing Address - Country:US
Mailing Address - Phone:798-383-9981
Mailing Address - Fax:798-383-9972
Practice Address - Street 1:101 MADIDON STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4210
Practice Address - Country:US
Practice Address - Phone:798-383-9981
Practice Address - Fax:798-383-9972
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036056738207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036056738Medicaid
IL700150Medicare UPIN
IL532440Medicare PIN