Healthcare Provider Details

I. General information

NPI: 1861044547
Provider Name (Legal Business Name): FATEMA MEWA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61637-0001
US

IV. Provider business mailing address

920 FROSTWOOD DR STE 2300 FL 2
HOUSTON TX
77024-2314
US

V. Phone/Fax

Practice location:
  • Phone: 309-624-8818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberU7473
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.147863
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberU7473
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: