Provider Demographics
NPI:1568637841
Name:MAHENDRA, SHEELA RAIKAR (MD)
Entity Type:Individual
Prefix:
First Name:SHEELA
Middle Name:RAIKAR
Last Name:MAHENDRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHEELA
Other - Middle Name:SUDHIR
Other - Last Name:RAIKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1725 W. HARRISON ST
Mailing Address - Street 2:PROFESSIONAL BUILDING, SUITE 710
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-942-2889
Mailing Address - Fax:312-563-2131
Practice Address - Street 1:1725 W. HARRISON ST
Practice Address - Street 2:PROFESSIONAL BUILDING, SUITE 710
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-942-2889
Practice Address - Fax:312-563-2131
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361350792080P0206X
DEC70004039208000000X
IL036.1350792080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics