Healthcare Provider Details

I. General information

NPI: 1386605061
Provider Name (Legal Business Name): NEHA IYENGAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS NEHA PATEL

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 S KEDZIE AVE
MERRIONETTE PARK IL
60803
US

IV. Provider business mailing address

2640 W 183RD ST
HOMEWOOD IL
60430
US

V. Phone/Fax

Practice location:
  • Phone: 708-388-4400
  • Fax: 708-389-8484
Mailing address:
  • Phone: 708-798-6633
  • Fax: 708-798-6790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036111405
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: