MEDICARE: DR. PREETI MIRCHANDANI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician		IL

General Provider Information

NPI Number	:	1720048580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PREETI MIRCHANDANI D.O.

Provider Business Mailing Address
First Line	:	1001 OAKLAND DR
Second Line	:
City	:	BARRINGTON
State	:	IL
Zip	:	60010-6308
Country	:	US
Telephone Number	:	847-445-6152
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 W HIGGINS RD
Second Line	:	SUITE 670
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60195-5220
Country	:	US
Telephone Number	:	847-884-7710
Fax Number	:	847-884-8094

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	07/09/2007

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