Provider Demographics
NPI:1548457104
Name:M L MEHRA MD LTD
Entity type:Organization
Organization Name:M L MEHRA MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEHRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-546-8862
Mailing Address - Street 1:2901 OLD JACKSONVILLE RD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-7437
Mailing Address - Country:US
Mailing Address - Phone:217-546-8862
Mailing Address - Fax:217-546-8803
Practice Address - Street 1:2901 OLD JACKSONVILLE RD
Practice Address - Street 2:SUITE B1
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7437
Practice Address - Country:US
Practice Address - Phone:217-546-8862
Practice Address - Fax:217-546-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1699728584OtherNPI
IL209750Medicare UPIN
ILK09421Medicare PIN