Individual provider · NPI-1

Dr. Kavitha Bathala, M.D.

Family Medicine · Tinley Park, IL

NPI number1861415747
StatusActive
Last updated in NPPESDec 31, 2012

Details

NPI
1861415747
Entity type
Individual (NPI-1)
Name
Dr. Kavitha Bathala
Credential
M.D.
Sex
Female
Sole proprietor
No
Enumeration date
Jul 25, 2006
Last updated
Dec 31, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine036106265ILYes

Practice location

6703 159th St
Suite 110
Tinley Park, IL 60477-1781

Phone 708-444-8282

Mailing address

Po Box 1119
Matteson, IL 60443-4119

Phone 708-747-5850 · Fax 708-747-9991

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