Individual
BAVNA BHAGAVAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(888) 584-7888
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(888) 584-7888
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
125.077773
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/01/2020
Last updated
06/02/2021
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