Basic Information
| Provider Information | |||||||||
| NPI: | 1003478512 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUKHADIA | ||||||||
| FirstName: | BHOOMIKA | ||||||||
| MiddleName: | ARVINDBHAI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4646 N MARINE DR DEPT OF | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606405759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735645235 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 MEMORIAL AVE | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211575726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2406862300 | ||||||||
| FaxNumber: | 2406862330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2019 | ||||||||
| LastUpdateDate: | 06/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 125073523 | IL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | D93257 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.