Basic Information
| Provider Information | |||||||||
| NPI: | 1992966592 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHAKTA | ||||||||
| FirstName: | KUNJAN | ||||||||
| MiddleName: | SATISHKUMAR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 N WESTMORELAND RD STE 100700 | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600451673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472344310 | ||||||||
| FaxNumber: | 2242714600 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 N WESTMORELAND RD STE 100700 | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600451673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472344310 | ||||||||
| FaxNumber: | 2242714600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2008 | ||||||||
| LastUpdateDate: | 01/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 4301085694 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | A99192 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 4301085694 | MI | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0127X | 036158123 | IL | Y | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery |
No ID Information.