Provider Demographics
NPI:1366624819
Name:MEHTA, ANJALI HEMU (MD)
Entity type:Individual
Prefix:
First Name:ANJALI
Middle Name:HEMU
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W. POLK STREET, A312
Mailing Address - Street 2:DIVISION OF RHEUMATOLOGY (MC733)
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-413-9310
Mailing Address - Fax:
Practice Address - Street 1:1819 W POLK ST STE A312
Practice Address - Street 2:DIVISION OF RHEUMATOLOGY, MC 733
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4356
Practice Address - Country:US
Practice Address - Phone:312-413-9310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.013938207R00000X
OH35.094770207R00000X
IL036-128280207R00000X
OR164564207RR0500X
IL036-12828207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine