Basic Information
| Provider Information | |||||||||
| NPI: | 1265609200 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEHTA | ||||||||
| FirstName: | MILAP | ||||||||
| MiddleName: | PANKAJ | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD. MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9650 GROSS POINT RD STE 1900 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600765006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2242512020 | ||||||||
| FaxNumber: | 2242512010 | ||||||||
| Practice Location | |||||||||
| Address1: | 9650 GROSS POINT RD STE 1900 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600765006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2242512020 | ||||||||
| FaxNumber: | 2242512010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2008 | ||||||||
| LastUpdateDate: | 11/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 036130685 | IL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.