Provider Demographics
NPI:1336170554
Name:MEHTA, ELISABETH L (MD)
Entity type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:L
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 S WASHINGTON
Mailing Address - Street 2:SUITE 122
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:847-692-6628
Mailing Address - Fax:847-692-6891
Practice Address - Street 1:101 S WASHINGTON
Practice Address - Street 2:SUITE 122
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-692-6628
Practice Address - Fax:847-692-6891
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036105049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics