Provider Demographics
NPI:1821016429
Name:MEHTA, DEEPAK S (MD)
Entity Type:Individual
Prefix:
First Name:DEEPAK
Middle Name:S
Last Name:MEHTA
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 1:104 N STAFFIRE DR
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3826
Mailing Address - Country:US
Mailing Address - Phone:847-858-1393
Mailing Address - Fax:847-882-3262
Practice Address - Street 1:104 N STAFFIRE DR
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3826
Practice Address - Country:US
Practice Address - Phone:847-858-1393
Practice Address - Fax:847-882-3262
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL484112OtherMEDICARE GROUP
ILD12910Medicare UPIN