Healthcare Provider Details

I. General information

NPI: 1417112665
Provider Name (Legal Business Name): SANGEETA MEHENDALE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANGEETA KARVE MD

II. Dates (important events)

Enumeration Date: 07/26/2008
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

821 WISCONSIN AVE
OAK PARK IL
60304-1043
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036126889
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number036126889
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: