Individual
MUKTESHWAR MEHRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2901 OLD JACKSONVILLE RD, SPRINGFIELD, IL 62704-7437
(217) 698-9722
(217) 391-0392
Mailing address
PO BOX 500, CHATHAM, IL 62629-0500
(217) 698-9722
(217) 391-0392
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
036046419
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020057300
BLACK LUNG PGA
IL
01
—
036046419
IL STATE LICENSE
IL
05
—
036046419
—
IL
01
—
08421024
BC/BS PGA
IL
01
—
133586700
ACS-OWCP PGA GROUP#
IL
01
—
14D0949277
CLIA PGA
IL
01
—
262941
HEALTHLINK
IL
01
—
330617
PERSONAL CARE
IL
01
—
6394P
CATERPILLAR PGA
IL
01
—
CD7143
PGA RR MEDICARE GROUP#
IL
01
—
P00453807
RR MED ID
IL
Enumeration date
05/19/2006
Last updated
10/01/2014
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