Healthcare Provider Details

I. General information

NPI: 1922085695
Provider Name (Legal Business Name): MAHIM K VORA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 VOLLMER ROAD SUITE 119
FLOSSMOOR IL
60426
US

IV. Provider business mailing address

112 SADDLEBROOK DRIVE
OAKBROOK IL
60523
US

V. Phone/Fax

Practice location:
  • Phone: 708-754-8815
  • Fax: 708-798-1315
Mailing address:
  • Phone: 708-535-1333
  • Fax: 708-535-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036058126
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: