Healthcare Provider Details

I. General information

NPI: 1508196742
Provider Name (Legal Business Name): AVINDER SINGH MEHTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27475 FERRY RD
WARRENVILLE IL
60555-3808
US

IV. Provider business mailing address

27475 FERRY RD
WARRENVILLE IL
60555-3808
US

V. Phone/Fax

Practice location:
  • Phone: 630-445-1654
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036126452
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: