Provider Demographics
NPI:1487732103
Name:BHOSALE, NITIN P (MD)
Entity type:Individual
Prefix:DR
First Name:NITIN
Middle Name:P
Last Name:BHOSALE
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 1:1408 ENGLISH OAK DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-3351
Mailing Address - Country:US
Mailing Address - Phone:217-766-5170
Mailing Address - Fax:888-665-3016
Practice Address - Street 1:411 N CLARENDON CT STE 104
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-6053
Practice Address - Country:US
Practice Address - Phone:815-683-6109
Practice Address - Fax:888-665-3016
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361181552083C0008X, 2084P0015X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H57786Medicare UPIN
IL6447860011Medicare NSC
IL0533210001Medicare NSC
ILIL3270343Medicare PIN
ILK38771Medicare PIN
ILH57786Medicare UPIN