Provider Demographics
NPI:1336481779
Name:MEHTA, GAUTAM RAJU (MBBS)
Entity type:Individual
Prefix:DR
First Name:GAUTAM
Middle Name:RAJU
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:RAJU
Other - Middle Name:
Other - Last Name:MEHTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-982-3362
Mailing Address - Fax:847-982-3394
Practice Address - Street 1:801 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7430
Practice Address - Country:US
Practice Address - Phone:630-527-3000
Practice Address - Fax:630-527-3371
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN61685207RC0200X
IL036140001207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine