Healthcare Provider Details

I. General information

NPI: 1700617701
Provider Name (Legal Business Name): ANUJ KAMLESH MEHTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 LEXINGTON DR STE B
BUFFALO GROVE IL
60089-6929
US

IV. Provider business mailing address

160 LEXINGTON DR STE B
BUFFALO GROVE IL
60089-6929
US

V. Phone/Fax

Practice location:
  • Phone: 224-676-0202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-310906
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: