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NPI Code Detail

MEDICARE: DR. DISHA MAHENDRA M.D.

MEDICARE: DR. DISHA MAHENDRA 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
1208M00000XHospitalist Physician01081389AIN
2207R00000XInternal Medicine Physician2010019223MO
3207R00000XInternal Medicine Physician036132932IL

General Provider Information

NPI Number : 1457662942
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DISHA MAHENDRA M.D.
Provider Business Mailing Address
First Line : 8993 PARKSIDE LN
Second Line :
City : SAINT JOHN
State : IN
Zip : 46373-8748
Country : US
Telephone Number : 630-664-9286
Fax Number :
Provider Business Practice Location Address
First Line : 2160 S 1ST AVE
Second Line : FAHEY BLDG ROOM 007
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-216-5118
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2010
Last Update Date : 02/19/2026

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