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General NPI Number Information
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NPI Number | 1932159449
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Entity Type | Individual
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Provider Name | SHARAD P MEHTA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 3800 W 203RD ST SUITE 202
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1184
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Country | US
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Telephone | 708-679-2660
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Fax | 708-503-3861
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Provider Business Mailing Address
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Address Line | 1040 SIERRA DR SUITE 400
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City | GREENWOOD
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State | IN
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Zip | 46143-7240
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Country | US
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Telephone | 317-528-4800
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Fax | 317-865-8319
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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 | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | 036053461
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License Number State | IL
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