DR. SHRUTI BAHADUR (NPI# 1508035304) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508035304 |
| Entity Type | Individual |
| Full Name | DR. SHRUTI BAHADUR |
| Credential | M.D. |
| Practice Address |
650 Dakota St Ste A Crystal Lake IL 60012 |
| Mailing Address |
650 Dakota St Ste A Crystal Lake IL 60012-3744 |
| Practice Telephone | 8154556000 |
| Practice Fax Number | 8153561104 |
| Mailing Telephone | 8154556000 |
| Mailing Fax Number | 8153561104 |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2019-01-31 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 036120476 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | STATE LICENSE | 036120476 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 360 Station Dr, Crystal Lake, IL 600147978 | 8153386600 | 8154558044 |
| 3707 Doty Rd Ste G, Woodstock, IL 60098 | 8153386600 | 8153372898 |
| Street Address |
650 DAKOTA ST STE A |
| City | CRYSTAL LAKE |
| State | IL |
| Zip Code | 60012 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336112911 | William Arthur Stinson | Internal Medicine | 650 Dakota St Ste A, Crystal Lake, IL 60012 | 2006-02-13 |
| 1922480342 | Heather Masters | Dietitian, Registered | 650 Dakota St Ste A, Crystal Lake, IL 60012 | 2015-06-22 |
| 1255689543 | Laura L Dagdick | Nurse Practitioner | 650 Dakota St Ste A, Crystal Lake, IL 60012-3744 | 2012-08-17 |
| 1407110034 | Lindsay Morgan Esch | Internal Medicine | 650 Dakota St Ste A, Crystal Lake, IL 60012 | 2012-06-28 |
| 1811218654 | Gary Lee Reschak | Pediatrics | 650 Dakota St Ste A, Crystal Lake, IL 60012-3744 | 2010-06-16 |
| 1174846141 | Joy A Valko | Psychologist | 650 Dakota St Ste A, Crystal Lake, IL 60012 | 2010-03-05 |
| 1265677199 | Robert Brizzolara | Internal Medicine | 650 Dakota St Ste A, Crystal Lake, IL 60012-3744 | 2008-12-05 |
| 1235390154 | Daniela Huerta De Hathaway | Internal Medicine | 650 Dakota St Ste A, Crystal Lake, IL 60012 | 2008-06-23 |
| 1881893303 | Boguslaw S Bonczak | Family Medicine | 650 Dakota St Ste A, Crystal Lake, IL 60012 | 2007-07-13 |
| 1134201908 | Lisa B Messinger | Pediatrics | 650 Dakota St Ste A, Crystal Lake, IL 60012 | 2006-10-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033574629 | Joan M Ryan | Counselor | 610 N Route 31, Suite E, Crystal Lake, IL 60012 | 2015-12-23 |
| 1285972331 | Lauren Elyse Westerman | Physical Therapist | 1000 Brighton Ln, Crystal Lake, IL 60012 | 2013-01-24 |
| 1447537469 | Sean Gale | Pharmacist | 135 Carmella Dr, Crystal Lake, IL 60012 | 2011-11-04 |
| 1477836625 | Judy Meekyung Fakhouri | Pharmacist | 315 N. Route 31, Crystal Lake, IL 60012 | 2011-09-23 |
| 1730462136 | Leslie Dawn Weckerlin | Pharmacist | 315 N Route 31, Crystal Lake, IL 60012 | 2011-09-21 |
| 1639452188 | Laura Jean Galles | Pharmacist | 315 N. Routet 31, Crystal Lake, IL 60012 | 2011-09-21 |
| 1326320516 | Stacey Jean Knuth | Pharmacist | 315 North Route 31, Crystal Lake, IL 60012 | 2011-09-13 |
| 1356469803 | Donn Orien Humphries | Chiropractor | 690 N Route 31, Suite F, Crystal Lake, IL 60012 | 2007-03-26 |
| 1538204508 | Midwest Physical Therapy Ctr | Clinic/Center | 630 N Rt 31, Suite 103, Crystal Lake, IL 60012 | 2007-02-20 |
| 1356488415 | Charlotte Joy Parcels | Social Worker | 8600 Route 14, Suite 110, Crystal Lake, IL 60012 | 2007-01-30 |
| Find all providers in zip 60012 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265917876 | Global Med Pro LLC | Family Medicine | 741 S Mchenry Ave Ste C&d, Crystal Lake, IL 60014-7445 | 2018-09-28 |
| 1588921951 | Khyldoon Selim Bajwa | Family Medicine | 2813 Stonegate Dr, Crystal Lake, IL 60012-1033 | 2012-04-23 |
| 1356653570 | Anthony J Weston | Family Medicine | 525 E Congress Pkwy Ste 350, Crystal Lake, IL 60014-6271 | 2010-07-02 |
| 1700106028 | Sumaira Jabeen | Family Medicine | 741 S Mchenry Ave Ste C, Crystal Lake, IL 60014 | 2010-06-09 |
| 1801856117 | John S Balocki | Family Medicine | 185 Heritage Drive, Suite 3, Crystal Lake, IL 60014 | 2006-03-23 |
| 1174503510 | Family Medicine for Mchenry County | Family Medicine | 1095 Pingree Rd, Suite 108, Crystal Lake, IL 60014-1725 | 2006-01-20 |
| 1356905194 | Illinois Primary & Immediate Care Inc | Family Medicine | 741 S Mchenry Ave Ste C, Crystal Lake, IL 60014-7445 | 2019-04-26 |
| 1356883599 | Centegra Primary Care LLC | Family Medicine | 420 N Il Route 31, Crystal Lake, IL 60012-3709 | 2016-11-04 |
| 1972814267 | Krishanthi Dilrukshi Seneviratne | Family Medicine | 415 E Congress Pkwy Ste A, Crystal Lake, IL 60014-6248 | 2010-07-01 |
| 1871779744 | Emily Shen | Family Medicine | 350 E Congress Pkwy, Crystal Lake, IL 60014-6284 | 2008-01-10 |
| Find all providers in CRYSTAL LAKE | ||||
| City | CRYSTAL LAKE |
| Zip Code | 60012 |
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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.