Provider Demographics
NPI:1629280839
Name:MEENA, HEMLATA (MD)
Entity type:Individual
Prefix:
First Name:HEMLATA
Middle Name:
Last Name:MEENA
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 1:1146 GUNDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2120
Mailing Address - Country:US
Mailing Address - Phone:646-982-9130
Mailing Address - Fax:
Practice Address - Street 1:3040 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-3638
Practice Address - Country:US
Practice Address - Phone:708-780-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31693207Q00000X
IL036148977207Q00000X, 207V00000X
IA41241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC316937Medicaid
SCAA3353365Medicare PIN
SCAA43353365Medicare PIN