Provider Demographics
NPI:1366129264
Name:BHATTARAI, SHRISTI (MBBS)
Entity type:Individual
Prefix:
First Name:SHRISTI
Middle Name:
Last Name:BHATTARAI
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 OAK PARK AVE UNIT 305
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-5571
Mailing Address - Country:US
Mailing Address - Phone:708-698-7845
Mailing Address - Fax:
Practice Address - Street 1:3200 OAK PARK AVE UNIT 305
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-5571
Practice Address - Country:US
Practice Address - Phone:708-698-7845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.081945207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine