Provider Demographics
NPI:1699783209
Name:BHAN, ADARSH KUMAR (MD)
Entity type:Individual
Prefix:
First Name:ADARSH
Middle Name:KUMAR
Last Name:BHAN
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 1:17850 KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2058
Mailing Address - Country:US
Mailing Address - Phone:708-799-8700
Mailing Address - Fax:708-957-1830
Practice Address - Street 1:17850 KEDZIE AVE
Practice Address - Street 2:SUITE 3250
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2058
Practice Address - Country:US
Practice Address - Phone:708-799-8700
Practice Address - Fax:708-957-1830
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03696218207RC0001X, 207RC0001X
IL036096218207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCI8250OtherPALMETTO GBA GROUP #
ILP00359385OtherPALMETTO GBA INDIVIUAL #
IL21622931OtherBCBS GROUP NUMBER
IL036096218Medicaid
IL526200OtherMEDICARE GROUP PROVIDER #
IL21622931OtherBCBS GROUP NUMBER
ILCI8250OtherPALMETTO GBA GROUP #