MEDICARE: MRS. LOPA M MEHTA M.S.

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	235Z00000X	Speech-Language Pathologist	146.012741	IL

General Provider Information

NPI Number	:	1508249582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOPA M MEHTA M.S.

Provider Business Mailing Address
First Line	:	211 E OHIO ST
Second Line	:	#2407
City	:	CHICAGO
State	:	IL
Zip	:	60611-3262
Country	:	US
Telephone Number	:	832-860-1391
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 E OHIO ST
Second Line	:	#2407
City	:	CHICAGO
State	:	IL
Zip	:	60611-3262
Country	:	US
Telephone Number	:	832-860-1391
Fax Number	:

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

Provider Enumeration Date	:	07/08/2015
Last Update Date	:	07/08/2015

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