| Bhallamd, LLC | |
|
4415 Harrison Street, #300 Hillside IL 60162-1953 | |
| (708) 632-5600 | |
| (708) 632-5602 |
| Full Name | Bhallamd, LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 4415 Harrison Street, #300, Hillside, Illinois |
| Authorized Official Name and Position | Jake Mathew (BUSINESS OFFICE MANAGER) |
| Authorized Official Contact | 7086325600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bhallamd, LLC 4415 Harrison Street, #300 Hillside IL 60162-1953 Ph: (708) 632-5600 | Bhallamd, LLC 4415 Harrison Street, #300 Hillside IL 60162-1953 Ph: (708) 632-5600 |
| NPI Number | 1710434964 |
|---|---|
| Provider Enumeration Date | 09/06/2016 |
| Last Update Date | 07/11/2023 |
| Certification Date | 07/11/2023 |
| Medicare PECOS PAC ID | 5890082572 |
|---|---|
| Medicare Enrollment ID | O20160923000186 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710434964 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Secondary |
| 207RG0300X | Internal Medicine - Geriatric Medicine | () | Primary |
| Provider Name | Samir Bhalla |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1922365170 PECOS PAC ID: 2466685698 Enrollment ID: I20160923000469 |
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