Individual
DR. M S BHAGAVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
645 S CENTRAL AVE, CHICAGO, IL 60644
(708) 275-7458
Mailing address
645 S CENTRAL AVE, CHICAGO, IL 60644-5059
(708) 275-7458
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-094099
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-094099-1
—
IL
Enumeration date
10/14/2005
Last updated
03/06/2017
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