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General NPI Number Information
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NPI Number | 1902186166
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Entity Type | Individual
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Provider Name | MINA MECHEAL BENJAMIN MEHANNI MD, MS
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Gender | Male
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Dates
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Enumeration Date | 08/19/2011
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 9200 W WISCONSIN AVE FL 4
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City | MILWAUKEE
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State | WI
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Zip | 53226-3522
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Country | US
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Telephone | 414-805-6850
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Fax | 414-805-6851
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Provider Business Mailing Address
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Address Line | PO BOX 959354
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City | SAINT LOUIS
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State | MO
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Zip | 63195-9354
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Country | US
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Telephone | 636-916-7272
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Fax | 636-916-7274
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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 | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 036152915
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 2022045774
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | BP10040686
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 62448
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036152915
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License Number State | IL
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