Individual
MAHIMA VEMUGANTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
701 W NORTH AVE, MELROSE PARK, IL 60160-1612
(708) 681-3200
Mailing address
701 W NORTH AVE, MELROSE PARK, IL 60160-1612
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085009560
IL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
01/17/2023
Last updated
05/31/2023
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