| Harshad M. Mehta Md Sc | |
|
2850 W. 95th Street Suite 206 Evergreen Park IL 60805 | |
| (708) 425-8900 | |
| (708) 425-9612 |
| Full Name | Harshad M. Mehta Md Sc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2850 W. 95th Street, Evergreen Park, Illinois |
| Authorized Official Name and Position | Harshad M. Mehta (PRESIDENT) |
| Authorized Official Contact | 7084258900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Harshad M. Mehta Md Sc 2850 W. 95th Street Suite 206 Evergreen Park IL 60805 Ph: (708) 425-8900 | Harshad M. Mehta Md Sc 2850 W. 95th Street Suite 206 Evergreen Park IL 60805 Ph: (708) 425-8900 |
| NPI Number | 1629334743 |
|---|---|
| Provider Enumeration Date | 04/03/2012 |
| Last Update Date | 04/03/2012 |
| Medicare PECOS PAC ID | 0244480861 |
|---|---|
| Medicare Enrollment ID | O20121017000210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629334743 | NPI | - | NPPES |
| 036051716 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 036-51716 (Illinois) | Primary |
| 2084P0802X | Psychiatry & Neurology - Addiction Psychiatry | 036-51716 (Illinois) | Secondary |
| Provider Name | Peggy Chou |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124144886 PECOS PAC ID: 4880617919 Enrollment ID: I20060104000498 |
| Provider Name | Harshad M Mehta |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407930100 PECOS PAC ID: 1951205566 Enrollment ID: I20121017000253 |
| Provider Name | Shina K Gordon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295197697 PECOS PAC ID: 8224320031 Enrollment ID: I20160714000307 |
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