Provider Demographics
NPI:1346358199
Name:MEHTA, SHRIKANT A (MD)
Entity Type:Individual
Prefix:MR
First Name:SHRIKANT
Middle Name:A
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 23RD AVE
Mailing Address - Street 2:AVON
Mailing Address - City:IL
Mailing Address - State:IL
Mailing Address - Zip Code:61415
Mailing Address - Country:US
Mailing Address - Phone:309-465-3129
Mailing Address - Fax:309-465-3219
Practice Address - Street 1:1800 23RD AVE
Practice Address - Street 2:AVON
Practice Address - City:IL
Practice Address - State:IL
Practice Address - Zip Code:61415
Practice Address - Country:US
Practice Address - Phone:309-465-3129
Practice Address - Fax:309-465-3219
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036056404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine