Provider Demographics
NPI:1649204991
Name:KAMAT, MEDHA VIVEK (MD)
Entity Type:Individual
Prefix:DR
First Name:MEDHA
Middle Name:VIVEK
Last Name:KAMAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 W HARRISON ST
Mailing Address - Street 2:DEPT. OF PEDS. JOHN H STROGER HOSPITAL OF COOK COUNTY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3714
Mailing Address - Country:US
Mailing Address - Phone:312-864-6000
Mailing Address - Fax:312-864-9124
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:DEPT. OF PEDS. JOHN H STROGER HOSPITAL OF COOK COUNTY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-6000
Practice Address - Fax:312-864-9124
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360740562080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine