Provider Demographics
NPI:1922034214
Name:WELLCARE NEONATOLOGIST
Entity Type:Organization
Organization Name:WELLCARE NEONATOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEONATOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-377-6541
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-0360
Mailing Address - Country:US
Mailing Address - Phone:630-377-6541
Mailing Address - Fax:630-377-5168
Practice Address - Street 1:300 RANDALL RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4200
Practice Address - Country:US
Practice Address - Phone:630-377-6541
Practice Address - Fax:630-377-5168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty