Provider Demographics
NPI:1295717643
Name:MEHTA, BHUPAT (MD)
Entity type:Individual
Prefix:
First Name:BHUPAT
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BHUPATKUMAR
Other - Middle Name:N
Other - Last Name:MEHTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:67 REGENT DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1745
Mailing Address - Country:US
Mailing Address - Phone:630-325-6151
Mailing Address - Fax:708-652-0058
Practice Address - Street 1:67 REGENT DR
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1745
Practice Address - Country:US
Practice Address - Phone:630-325-6151
Practice Address - Fax:708-652-0058
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055686207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL110047291OtherRR MEDICARE PIN
IL131009OtherADVOCATE HEALTH PARNERS PIN
IL2487312OtherAETNA
IL036055686Medicaid
IL2221466OtherBLUE SHIELD
IL131009OtherADVOCATE HEALTH PARNERS PIN
IL710200Medicare PIN