Provider Demographics
NPI:1942628789
Name:PARMAR, MITALI
Entity Type:Individual
Prefix:
First Name:MITALI
Middle Name:
Last Name:PARMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E OHIO ST
Mailing Address - Street 2:APT 2110
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3262
Mailing Address - Country:US
Mailing Address - Phone:716-380-7144
Mailing Address - Fax:
Practice Address - Street 1:240 E HURON ST
Practice Address - Street 2:MCGAW PAVILLION
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-503-7975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-30
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA154114207P00000X
IL125064547207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine