Provider Demographics
NPI:1932159449
Name:MEHTA, SHARAD P (MD)
Entity Type:Individual
Prefix:
First Name:SHARAD
Middle Name:P
Last Name:MEHTA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7240
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-8319
Practice Address - Street 1:3800 W 203RD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1184
Practice Address - Country:US
Practice Address - Phone:708-679-2660
Practice Address - Fax:708-503-3861
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-09-06
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Provider Licenses
StateLicense IDTaxonomies
IL036053461207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053461Medicaid
ILL95602Medicare ID - Type UnspecifiedFEE SCHEDULE LOCALITY 16
ILL95603Medicare ID - Type UnspecifiedFEE SCHEDULE LOCALITY 15
IL036053461Medicaid