Provider Demographics
NPI:1245202068
Name:BAHU, AMIRA MARY (MD)
Entity type:Individual
Prefix:DR
First Name:AMIRA
Middle Name:MARY
Last Name:BAHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:618-257-5613
Mailing Address - Fax:314-454-4641
Practice Address - Street 1:4500 MEMORIAL DR
Practice Address - Street 2:DEPT RADIOLOGY
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5360
Practice Address - Country:US
Practice Address - Phone:618-257-5613
Practice Address - Fax:314-454-4641
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361094602085R0202X, 2085R0202X
WI443682085R0202X
IN01059870A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200092994Medicaid
ILF400112429Medicare PIN
ILK06062Medicare PIN
ILK01872Medicare ID - Type UnspecifiedGRC COOK COUNTY
ILK22459Medicare ID - Type UnspecifiedGMI COOK COUNTY
ILH66324Medicare UPIN
ILK01276Medicare ID - Type UnspecifiedMIDWESTERN REGIONAL
ILK01736Medicare ID - Type UnspecifiedGRC LAKE COUNTY