Healthcare Provider Details

I. General information

NPI: 1679830459
Provider Name (Legal Business Name): NEHA MALHOTRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S WOOD ST SUITE 515 CSN
CHICAGO IL
60612
US

IV. Provider business mailing address

1224 W VAN BUREN ST APT 313
CHICAGO IL
60607-3361
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-9330
  • Fax:
Mailing address:
  • Phone: 847-710-4674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberX
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number10796727-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: