Provider Demographics
NPI:1598856643
Name:MEDHAT, ARDESHIR R (MD)
Entity Type:Individual
Prefix:
First Name:ARDESHIR
Middle Name:R
Last Name:MEDHAT
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 1:222 E DUNDEE RD
Mailing Address - Street 2:HARVEY ANESTHESIOLOGISTS SC
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090
Mailing Address - Country:US
Mailing Address - Phone:847-520-0235
Mailing Address - Fax:847-520-0390
Practice Address - Street 1:ONE INGALLS DR
Practice Address - Street 2:INGALLS MEMORIAL HOSPITAL
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426
Practice Address - Country:US
Practice Address - Phone:708-333-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P03653Medicare ID - Type Unspecified
C43637Medicare UPIN