Provider Demographics
NPI:1487727731
Name:BHATTACHARYA, ISHAN (MD)
Entity type:Individual
Prefix:DR
First Name:ISHAN
Middle Name:
Last Name:BHATTACHARYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6138
Mailing Address - Country:US
Mailing Address - Phone:309-277-1143
Mailing Address - Fax:
Practice Address - Street 1:545 VALLEY VIEW DR
Practice Address - Street 2:GASTROENTEROLOGY CONSULTANTS ATTN BECKY BRANNON
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6138
Practice Address - Country:US
Practice Address - Phone:309-762-5560
Practice Address - Fax:309-762-7351
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068763207RG0100X
UT14199050-1235207RG0100X
IAMD-48413207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
018590K92Medicare ID - Type Unspecified
E24369Medicare UPIN