Basic Information
| Provider Information | |||||||||
| NPI: | 1750310553 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOBAT | ||||||||
| FirstName: | ISMAIL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 RELIABLE PKWY | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606865300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086331234 | ||||||||
| FaxNumber: | 7083427272 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 WEST PARK ST | ||||||||
| Address2: | SUITE D2248 | ||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618012396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173373738 | ||||||||
| FaxNumber: | 2173374569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 11/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | 036-110991 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RC0200X | 036-110991 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 036110991 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | CA2264 | 01 | IL | RR GROUP | OTHER | 036110991 | 01 | IL | ILLINOIS MEDICAL LICENSE | OTHER | 036110991 | 05 | IL | MEDICAID | 833120 | 01 | IL | MEDICARE GROUP # | OTHER | 35437 | 01 | IA | IOWA MEDICAL LICENSE | OTHER | 4301078417 | 01 | MI | MICHIGAN MEDICAL LICENSE | OTHER | BB8686670 | 01 | DEA | OTHER | P00446526 | 01 | IL | RR INDIVIDUAL | OTHER |