Provider Demographics
NPI:1932405560
Name:MITHAL, LEENA BHATTACHARYA (MD, MSCI)
Entity type:Individual
Prefix:DR
First Name:LEENA
Middle Name:BHATTACHARYA
Last Name:MITHAL
Suffix:
Gender:F
Credentials:MD, MSCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E CHICAGO AVE STE 1800
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-4080
Mailing Address - Fax:312-227-9709
Practice Address - Street 1:225 E CHICAGO AVE STE 1800
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-4080
Practice Address - Fax:312-227-9709
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-29
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036127299208000000X
TXBP10030747208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics