Basic Information
| Provider Information | |||||||||
| NPI: | 1134299779 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BARISURA PRIVATE LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9410 COMPUBILL DR | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084607444 | ||||||||
| FaxNumber: | 7084608662 | ||||||||
| Practice Location | |||||||||
| Address1: | 9011 S COMMERCIAL AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739330700 | ||||||||
| FaxNumber: | 7739337407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BISLA | ||||||||
| AuthorizedOfficialFirstName: | VIRENDRA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7739330700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Nuclear Medicine | 207UN0901X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology |
No ID Information.