Individual
SURABHI MEHROTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1645 W JACKSON BLVD, SUITE 215, CHICAGO, IL 60612-3276
(312) 942-8000
Mailing address
1645 W JACKSON BLVD STE 215, CHICAGO, IL 60612-3227
(312) 942-8000
Taxonomy
Speciality
Code
Description
License number
State
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
Primary
036-114308
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-114308
—
IL
Enumeration date
06/01/2006
Last updated
07/05/2011
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