Provider Demographics
NPI:1558300319
Name:MEHTA, SANDEEP D
Entity Type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:D
Last Name:MEHTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-570-2040
Mailing Address - Fax:
Practice Address - Street 1:767 PARK AVE W STE 260
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2471
Practice Address - Country:US
Practice Address - Phone:847-432-7222
Practice Address - Fax:847-432-9360
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112471208M00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112471Medicaid
ILK16405Medicare ID - Type UnspecifiedDUPAGE
ILK16404Medicare ID - Type UnspecifiedCOOK
IL036112471Medicaid