Provider Demographics
NPI:1811175003
Name:MEHTA, AMIT BAKULESH (MD)
Entity type:Individual
Prefix:DR
First Name:AMIT
Middle Name:BAKULESH
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1365 WILEY ROAD
Mailing Address - Street 2:SUITE 153
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4357
Mailing Address - Country:US
Mailing Address - Phone:847-519-4701
Mailing Address - Fax:847-519-4707
Practice Address - Street 1:1365 WILEY ROAD
Practice Address - Street 2:SUITE 153
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4357
Practice Address - Country:US
Practice Address - Phone:847-519-4701
Practice Address - Fax:847-519-4707
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-10
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036120218207LP2900X, 207L00000X
NY243341-1207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036120218Medicaid
IL036120218Medicaid
ILK53217Medicare PIN