Provider Demographics
NPI:1104012053
Name:MUKESH M. DOSHI, M.D., S.C.
Entity Type:Organization
Organization Name:MUKESH M. DOSHI, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUKESH
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-882-4300
Mailing Address - Street 1:1768 MOON LAKE BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169
Mailing Address - Country:US
Mailing Address - Phone:847-882-4300
Mailing Address - Fax:847-882-7269
Practice Address - Street 1:1768 MOON LAKE BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169
Practice Address - Country:US
Practice Address - Phone:847-882-4300
Practice Address - Fax:847-882-7269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD16540Medicare UPIN
IL606400Medicare PIN