MEDICARE: DR. MEHUL K. SHETH D.O.

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	208000000X	Pediatrics Physician	036115143	IL

General Provider Information

NPI Number	:	1518165471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEHUL K. SHETH D.O.

Provider Business Mailing Address
First Line	:	10000 W INNOVATION DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-4837
Country	:	US
Telephone Number	:	414-456-5006
Fax Number	:	414-456-6259

Provider Business Practice Location Address
First Line	:	200 W RAND RD
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-1132
Country	:	US
Telephone Number	:	847-979-5437
Fax Number	:	847-979-9907

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

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	06/07/2023

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