Individual
DR. GAUTAM K BHANUSHALI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2701 W 68TH STREET, PROFESSIONAL PAVILION 4 SOUTH, CHICAGO, IL 60629
(773) 735-4884
Mailing address
120 W 22ND ST STE 200, OAK BROOK, IL 60523-1563
(630) 573-5000
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
036132193
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
922820024
MEDICARE
IL
Enumeration date
08/30/2010
Last updated
08/04/2025
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