Healthcare Provider Details

I. General information

NPI: 1972777126
Provider Name (Legal Business Name): MEHUL VASANTKUMAR RAVAL M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE # 63
CHICAGO IL
60611
US

IV. Provider business mailing address

225 E CHICAGO AVE # 63
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 336-575-7783
  • Fax:
Mailing address:
  • Phone: 336-575-7783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number036118670
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: