Individual
DR. MOHAN PHATAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7435 W TALCOTT AVE, CHICAGO, IL 60631-3707
(773) 792-5138
(773) 792-5124
Mailing address
PO BOX 68, NORTHBROOK, IL 60065-0068
(847) 412-9213
(847) 412-9381
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
IL
2085N0700X
Neuroradiology Physician
—
IL
2085N0904X
Nuclear Radiology Physician
—
IL
2085P0229X
Pediatric Radiology Physician
Primary
—
IL
2085R0202X
Diagnostic Radiology Physician
—
IL
2085U0001X
Diagnostic Ultrasound Physician
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001619902
BLUE CROSS BLUE SHIELD-IL
IL
05
—
036053629-1
—
IL
Enumeration date
07/12/2006
Last updated
09/11/2025
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