Healthcare Provider Details

I. General information

NPI: 1316958010
Provider Name (Legal Business Name): IRINA MESHEM NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 LAKE COOK RD
RIVERWOODS IL
60015-3851
US

IV. Provider business mailing address

25233 NETWORK PLACE
CHICAGO IL
60673-1252
US

V. Phone/Fax

Practice location:
  • Phone: 224-405-2800
  • Fax: 224-405-4928
Mailing address:
  • Phone: 630-390-1240
  • Fax: 630-390-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209-006063
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: