Individual
MRS. MUKUNDINI S MEHTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5909 W 35TH ST, CICERO, IL 60804-4163
(708) 652-2040
(708) 652-0058
Mailing address
5909 W 35TH ST, CICERO, IL 60804-4163
(708) 652-2040
(708) 652-0058
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
363659220
IL
207VG0400X
Gynecology Physician
36059220
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036059220
—
IL
01
—
1411
CHICAGO HEALTH SERVICES (CHS) PIN
IL
01
—
160025319
RR MEDICARE PIN
IL
01
—
31603182
BCBS
IL
Enumeration date
11/21/2005
Last updated
01/11/2024
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