Provider Demographics
NPI:1285768531
Name:BIPIN N. BHAYANI M.D.,S.C.
Entity type:Organization
Organization Name:BIPIN N. BHAYANI M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BIPIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:BHAYANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-939-3190
Mailing Address - Street 1:455 W COURT ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3679
Mailing Address - Country:US
Mailing Address - Phone:815-939-3190
Mailing Address - Fax:
Practice Address - Street 1:455 W COURT ST
Practice Address - Street 2:SUITE 403
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3679
Practice Address - Country:US
Practice Address - Phone:815-939-3190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory