Provider Demographics
NPI:1649633918
Name:KELTA, MOUHAMMED (MD)
Entity type:Individual
Prefix:
First Name:MOUHAMMED
Middle Name:
Last Name:KELTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62647 COLLECTION CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60693-0626
Mailing Address - Country:US
Mailing Address - Phone:708-478-4302
Mailing Address - Fax:708-265-1724
Practice Address - Street 1:1 ANDREW CT
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-8128
Practice Address - Country:US
Practice Address - Phone:630-560-9288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-03
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087250207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology