Healthcare Provider Details

I. General information

NPI: 1295717643
Provider Name (Legal Business Name): BHUPAT MEHTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BHUPATKUMAR N MEHTA M.D.

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 REGENT DR
OAK BROOK IL
60523-1745
US

IV. Provider business mailing address

67 REGENT DR
OAK BROOK IL
60523-1745
US

V. Phone/Fax

Practice location:
  • Phone: 630-325-6151
  • Fax: 708-652-0058
Mailing address:
  • Phone: 630-325-6151
  • Fax: 708-652-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036055686
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: