Healthcare Provider Details

I. General information

NPI: 1417932955
Provider Name (Legal Business Name): MIHIR MAJMUNDAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9921 SOUTHWEST HWY
OAK LAWN IL
60453-3767
US

IV. Provider business mailing address

9921 SOUTHWEST HWY
OAK LAWN IL
60453-3767
US

V. Phone/Fax

Practice location:
  • Phone: 708-499-5678
  • Fax: 708-499-5685
Mailing address:
  • Phone: 708-499-5678
  • Fax: 708-499-5685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036-088879
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number75757
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: