Provider Demographics
NPI:1174705321
Name:MOHAN, VIVEK (MD, MS)
Entity type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:
Last Name:MOHAN
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E WOODFIELD RD STE 111
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4763
Mailing Address - Country:US
Mailing Address - Phone:630-381-1381
Mailing Address - Fax:630-381-1385
Practice Address - Street 1:800 E WOODFIELD RD STE 111
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4763
Practice Address - Country:US
Practice Address - Phone:630-381-1381
Practice Address - Fax:630-381-1385
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112008207XS0117X
IL036125332207XS0117X
IL036.125332207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036125332Medicaid