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General NPI Number Information
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NPI Number | 1194930339
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Entity Type | Individual
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Provider Name | NIVEDITA MOHANTY MD
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 1701 W SUPERIOR ST
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City | CHICAGO
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State | IL
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Zip | 60622-5646
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Country | US
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Telephone | 312-666-3488
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Fax |
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Provider Business Mailing Address
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Address Line | 1642 E 56TH ST APT 416
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City | CHICAGO
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State | IL
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Zip | 60637-1952
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Country | US
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Telephone | 773-288-3682
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036118091
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036.118091
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License Number State | IL
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