Provider Demographics
NPI:1689759177
Name:DOSHI, MUKESH M (MD)
Entity Type:Individual
Prefix:DR
First Name:MUKESH
Middle Name:M
Last Name:DOSHI
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 1:1540 SANDBURG DR
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-2183
Mailing Address - Country:US
Mailing Address - Phone:224-558-4345
Mailing Address - Fax:
Practice Address - Street 1:1540 SANDBURG DR
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-2183
Practice Address - Country:US
Practice Address - Phone:224-558-4345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-058559208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
316-04415OtherBLUE CROSS BLUE SHEILD
IL036058559Medicaid
606400Medicare PIN
IL036058559Medicaid