Healthcare Provider Details

I. General information

NPI: 1659784817
Provider Name (Legal Business Name): ASHESHA MECHINENI MD, FACP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2242 W HARRISON ST STE 104
CHICAGO IL
60612-3515
US

IV. Provider business mailing address

2242 W HARRISON ST STE 104
CHICAGO IL
60612-3515
US

V. Phone/Fax

Practice location:
  • Phone: 312-355-1091
  • Fax: 312-413-0503
Mailing address:
  • Phone: 312-355-1091
  • Fax: 312-413-0503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA09894100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number036.155454
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: