Provider Demographics
NPI:1750557815
Name:MEHTA, PARTH HEMANTKUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:PARTH
Middle Name:HEMANTKUMAR
Last Name:MEHTA
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 1:11220 N GREENVIEW LN
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:IL
Mailing Address - Zip Code:61525-7542
Mailing Address - Country:US
Mailing Address - Phone:630-857-8839
Mailing Address - Fax:
Practice Address - Street 1:221 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61636-5640
Practice Address - Country:US
Practice Address - Phone:309-672-5729
Practice Address - Fax:309-672-5772
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123967208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist