Individual
RENUKA BHASKAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
105 KRISPY KREME DR, STE 4, BLOOMINGTON, IL 61704-3751
(309) 585-2837
Mailing address
2200 JACOBSSEN DR STE B, NORMAL, IL 61761-5516
(309) 451-1123
(309) 451-1212
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
036-107260
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467751156
—
IL
01
—
1942501978
BLUECROSSBLUE SHIELD O
IL
Enumeration date
07/10/2006
Last updated
12/08/2023
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