Basic Information
| Provider Information | |||||||||
| NPI: | 1346419827 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BHARATI CHITTINENI MD SC | ||||||||
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| OtherOrganizationName: | NAPERBROOK DERMATOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6547 N AVONDALE AVE | ||||||||
| Address2: | SUITE 001 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606311573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737751622 | ||||||||
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| Practice Location | |||||||||
| Address1: | 550 E BOUGHTON RD | ||||||||
| Address2: | SUITE 170 | ||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604402100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307393376 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2008 | ||||||||
| LastUpdateDate: | 06/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | CHITTINENI | ||||||||
| AuthorizedOfficialFirstName: | BHARATI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6307393376 | ||||||||
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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 | 207N00000X | 036105923 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 036105923 | 05 | IL | MEDICAID |