| Mohana Health Care Ltd | |
|
3641 E 108th St Chicago IL 60617-6951 | |
| (773) 731-5466 | |
| (773) 731-5461 |
| Full Name | Mohana Health Care Ltd |
|---|---|
| Speciality | Family Medicine |
| Location | 3641 E 108th St, Chicago, Illinois |
| Authorized Official Name and Position | Bhargavi Nettem (PRESIDENT) |
| Authorized Official Contact | 7737315466 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mohana Health Care Ltd 5843 N Saint Johns Ct Chicago IL 60646-6048 Ph: () - | Mohana Health Care Ltd 3641 E 108th St Chicago IL 60617-6951 Ph: (773) 731-5466 |
| NPI Number | 1083803902 |
|---|---|
| Provider Enumeration Date | 10/16/2007 |
| Last Update Date | 07/09/2024 |
| Medicare PECOS PAC ID | 8224074976 |
|---|---|
| Medicare Enrollment ID | O20050701000896 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083803902 | NPI | - | NPPES |
| 036103788 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036103788 (Illinois) | Primary |
| Provider Name | Bhargavi Nettem |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811098783 PECOS PAC ID: 3476599127 Enrollment ID: I20050705000034 |
| Provider Name | Jayesh M Madhani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457461576 PECOS PAC ID: 0244381887 Enrollment ID: I20090622000661 |
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