Provider Demographics
NPI:1992966592
Name:BHAKTA, KUNJAN SATISHKUMAR (MD)
Entity type:Individual
Prefix:
First Name:KUNJAN
Middle Name:SATISHKUMAR
Last Name:BHAKTA
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 1:800 N WESTMORELAND RD STE 100700
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1673
Mailing Address - Country:US
Mailing Address - Phone:847-234-4310
Mailing Address - Fax:224-271-4600
Practice Address - Street 1:800 N WESTMORELAND RD STE 100700
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1673
Practice Address - Country:US
Practice Address - Phone:847-234-4310
Practice Address - Fax:224-271-4600
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085694208600000X, 2086S0102X
CAA99192208600000X
IL0361581232086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care