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Individual

ILA N MEHTA III

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
375 DIXMYTH AVE, CINCINNATI, OH 45220-2475
(513) 624-4337
Mailing address
PO BOX 632242, CINCINNATI, OH 45263-2242
(800) 503-6254

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
35040388
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0404584
OH
05
200234420A
IN
05
200234420C
IN
05
200234420D
IN
05
200234420E
IN
05
200234420F
IN
01
220014349
RAILROAD MEDICARE
05
64935885
KY
Enumeration date
01/11/2006
Last updated
06/10/2010
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