Healthcare Provider Details

I. General information

NPI: 1982913661
Provider Name (Legal Business Name): MEENA S GEORGE M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 159TH ST SUITE A
OAK FOREST IL
60452-2776
US

IV. Provider business mailing address

6320 W 159TH STREET SUITE A
OAK FOREST IL
60452
US

V. Phone/Fax

Practice location:
  • Phone: 708-687-2222
  • Fax: 708-687-3829
Mailing address:
  • Phone: 708-687-2222
  • Fax: 708-687-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number036141259
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036141259
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: