Healthcare Provider Details

I. General information

NPI: 1215184577
Provider Name (Legal Business Name): SHEETAL M KIRCHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHEETAL UJJWAL MEHTA MD

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 21-100
CHICAGO IL
60611-5970
US

IV. Provider business mailing address

3621 S STATE ST 700 KMS PLACE
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0990
  • Fax: 312-695-1106
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125051647
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301099746
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number4301099746
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number4301099746
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number036123432
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: