DR. GAUTAM K BHANUSHALI (NPI# 1073829990) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073829990 |
| Entity Type | Individual |
| Full Name | DR. GAUTAM K BHANUSHALI |
| Credential | MD |
| Practice Address |
2701 W 68th Street Professional Pavilion 4 South Chicago IL 60629 |
| Mailing Address |
120 W 22nd St Ste 200 Oak Brook IL 60523-1563 |
| Practice Telephone | 7737354884 |
| Mailing Telephone | 6305755000 |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2020-10-27 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 125053936 | IL | Allopathic & Osteopathic Physicians |
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
036132193 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDICARE | 922820024 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1900 W Polk St, 15th Floor, Dept of Medicine, Chicago, IL 606123723 | 3123512829 |
| Street Address |
2701 W 68TH STREET PROFESSIONAL PAVILION 4 SOUTH |
| City | CHICAGO |
| State | IL |
| Zip Code | 60629 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336125327 | Wadah Atassi | Internal Medicine | 2701 W 68th Street, Professional Pavilion 4 South, Chicago, IL 60629-1813 | 2005-12-21 |
| 1740374461 | Mark Jordan | Psychologist | 2701 W 68th Street, Chicago, IL 60629 | 2006-10-03 |
| 1558455170 | Marlene Krupa | Psychologist | 2701 W 68th Street, Chicago, IL 60629 | 2006-10-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053946392 | T & M Care LLC | In Home Supportive Care | 7230 S Talman, Apt 4, Chicago, IL 60629 | 2020-03-06 |
| 1841847811 | Jacqueline Ann Milton | Technician | 6720 South Keating, Chicago, IL 60629 | 2019-08-23 |
| 1194202085 | Andrea Mosqueda | Counselor | 4217 W 59th St, Chicago, IL 60629 | 2018-07-23 |
| 1316439235 | Saliha Awais | Dentist | 5521 S. Kedzie Ave. Suite 105, Chicago, IL 60629 | 2018-06-06 |
| 1356833255 | Irfana Ilyas | Dentist | 2403,5521 S Kedzie Ave, Suite 105, Chicago, IL 60629 | 2018-06-06 |
| 1427547538 | Holy Cross Hospital | Psychiatric Unit | 2701 West 68th Street, Chicago, IL 60629 | 2018-05-03 |
| 1871003715 | Siddhi Vinayak Dental | Clinic/Center | 5521 S Kedzie Ave, Unit 105, Chicago, IL 60629 | 2017-10-05 |
| 1477092328 | Debra Shepard | Social Worker | 2601 W. Marquette Rd., Catholic Charities, Chicago, IL 60629 | 2017-02-13 |
| 1255777108 | Jacquelyn Jones | Developmental Therapist | 3108 West Marquette Road Apartment 1-b, Chicago, IL 60629 | 2013-05-20 |
| 1124368030 | Claudia Ballesteros | Interpreter | 5631 S. Richmond, Chicago, IL 60629 | 2013-03-01 |
| Find all providers in zip 60629 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235627332 | Chicago Nephrology Associates, LLC | Internal Medicine | 3023 N Clark St #302, Chicago, IL 60657 | 2018-04-25 |
| 1619328820 | Nay Seif | Internal Medicine | 675 N Saint Clair St Ste 250, Chicago, IL 60611-5975 | 2016-06-29 |
| 1447611389 | Skyline Medical Associates LLC | Internal Medicine | 100 E 14th St Apt 1907, Chicago, IL 60605-3673 | 2016-03-18 |
| 1972936581 | Marshall David Lindheimer | Internal Medicine | 5807 S Dorchester Ave, 5e, Chicago, IL 60637-1729 | 2013-08-19 |
| 1952656167 | Primecare Nephrology & Hypertension Sc Corp | Internal Medicine | 4810 S Kenwood Ave, Chicago, IL 60615-2016 | 2012-07-13 |
| 1558650697 | Stephanie Michelle Toth-manikowski | Internal Medicine | 820 S Wood St # Mc793, Chicago, IL 60612 | 2011-03-29 |
| 1326372855 | Daniel Fantus | Internal Medicine | 240 E Huron St Ste 1-200, Chicago, IL 60611-2909 | 2009-09-30 |
| 1487882791 | Sylvester Barnes Iv | Internal Medicine | 900 S Clark St Apt 1801, Chicago, IL 60605 | 2009-06-24 |
| 1952551517 | Jane Vernik Md, S.c. | Internal Medicine | 637 South Wood Street St 215, Division of Nephrology, Durand Building, Chicago, IL 60612 | 2008-09-19 |
| 1073643193 | Malathi Shah | Internal Medicine | 1625 E 75th St Ste 328, Chicago, IL 60649-3603 | 2007-03-07 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.