Provider Demographics
NPI:1699069880
Name:BHAVE, MANALI AJAY (MD)
Entity type:Individual
Prefix:
First Name:MANALI
Middle Name:AJAY
Last Name:BHAVE
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 1:220 E ILLINOIS ST APT 1106
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4365
Mailing Address - Country:US
Mailing Address - Phone:224-420-1103
Mailing Address - Fax:
Practice Address - Street 1:251 E HURON ST
Practice Address - Street 2:NORTHWESTERN MEMORIAL HOSPITAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:224-420-1103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-05
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125059165207R00000X
GA-207RX0202X
GA080666207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine