Provider Demographics
NPI:1972596021
Name:MEHTA, SEMIL B (MD)
Entity type:Individual
Prefix:DR
First Name:SEMIL
Middle Name:B
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2151 WAUKEGAN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1857
Mailing Address - Country:US
Mailing Address - Phone:847-236-1300
Mailing Address - Fax:847-236-9637
Practice Address - Street 1:2151 WAUKEGAN RD STE 110
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1857
Practice Address - Country:US
Practice Address - Phone:847-236-1300
Practice Address - Fax:847-236-9637
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103163207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103163Medicaid
IL36-3200051OtherFEIN
IL36-3200051OtherFEIN