Provider Demographics
NPI:1730238874
Name:AGARWAL, MAHESH K (MD)
Entity type:Individual
Prefix:DR
First Name:MAHESH
Middle Name:K
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 S GREENLEAF ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3398
Mailing Address - Country:US
Mailing Address - Phone:847-662-5100
Mailing Address - Fax:847-662-5112
Practice Address - Street 1:200 S GREENLEAF
Practice Address - Street 2:SUITE G
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3398
Practice Address - Country:US
Practice Address - Phone:847-662-5100
Practice Address - Fax:847-662-5112
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL3644722207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036044722Medicaid
D14242Medicare UPIN
K20249Medicare ID - Type Unspecified