Provider Demographics
NPI:1023264819
Name:BHARDWAJ, ANITA RANI (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:RANI
Last Name:BHARDWAJ
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 1:2540 N IL ROUTE 83
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-4905
Mailing Address - Country:US
Mailing Address - Phone:847-356-2752
Mailing Address - Fax:847-356-2763
Practice Address - Street 1:2540 N IL ROUTE 83
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073-4905
Practice Address - Country:US
Practice Address - Phone:847-356-2752
Practice Address - Fax:847-356-2763
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0026788207Q00000X
IL125.052953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine