Provider Demographics
NPI:1841227618
Name:SANGHANI, RUPA MEHTA
Entity Type:Individual
Prefix:
First Name:RUPA
Middle Name:MEHTA
Last Name:SANGHANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RUPA
Other - Middle Name:
Other - Last Name:MEHTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 W. CONGRESS PARKWAY
Mailing Address - Street 2:SUITE 318 KELLOG
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 1159
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-5020
Practice Address - Fax:312-942-4039
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-108792207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH61183Medicare UPIN
NY42S001Medicare ID - Type Unspecified