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NPI Code Detail

MEDICARE: NIVEDITA MANDAL MISHRA MD

MEDICARE: NIVEDITA MANDAL MISHRA MD
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
1207RG0100XGastroenterology Physician125078016IL
2207R00000XInternal Medicine Physician125.078016IL

General Provider Information

NPI Number : 1699352278
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIVEDITA MANDAL MISHRA MD
Provider Business Mailing Address
First Line : 2160 S 1ST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2160 S 1ST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 888-584-7888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2021
Last Update Date : 02/05/2026

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Directions to “ NIVEDITA MANDAL MISHRA MD” Practice Location

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