Provider Demographics
NPI:1730826900
Name:BHALLA, RAHUL (MD)
Entity type:Individual
Prefix:
First Name:RAHUL
Middle Name:
Last Name:BHALLA
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 1:2107 DEBBIE CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2886
Mailing Address - Country:US
Mailing Address - Phone:630-209-3482
Mailing Address - Fax:
Practice Address - Street 1:1300 FRANKLIN AVE STE 110
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3799
Practice Address - Country:US
Practice Address - Phone:309-268-3558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.079765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine