Provider Demographics
NPI:1821191958
Name:MALHOTRA, MEENA (MD)
Entity Type:Individual
Prefix:DR
First Name:MEENA
Middle Name:
Last Name:MALHOTRA
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:TECHNY
Mailing Address - State:IL
Mailing Address - Zip Code:60082-0068
Mailing Address - Country:US
Mailing Address - Phone:847-686-4444
Mailing Address - Fax:
Practice Address - Street 1:1122 WILLOW RD
Practice Address - Street 2:SUITE B
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6824
Practice Address - Country:US
Practice Address - Phone:847-686-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114659207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212737OtherMEDICARE
K23481Medicare UPIN