MEDICARE: DR. RUPAL C MEHTA M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	UNKNOWN	OH
2	207R00000X	Internal Medicine Physician	036.129948	IL
3	207RN0300X	Nephrology Physician	036.129948	IL

General Provider Information

NPI Number	:	1093963738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUPAL C MEHTA M.D

Provider Business Mailing Address
First Line	:	633 N SAINT CLAIR ST
Second Line	:	18TH FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60611-3234
Country	:	US
Telephone Number	:	312-503-1536
Fax Number	:	312-503-5656

Provider Business Practice Location Address
First Line	:	633 N SAINT CLAIR ST
Second Line	:	18TH FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60611-3234
Country	:	US
Telephone Number	:	312-503-1536
Fax Number	:	312-503-5656

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2008
Last Update Date	:	08/11/2014

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