Provider Demographics
NPI:1174995914
Name:MEHTA, KANAKKUMAR MADANLAL
Entity type:Individual
Prefix:MR
First Name:KANAKKUMAR
Middle Name:MADANLAL
Last Name:MEHTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 W BIRCHWOOD AVE
Mailing Address - Street 2:UNIT # A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1666
Mailing Address - Country:US
Mailing Address - Phone:773-387-4997
Mailing Address - Fax:
Practice Address - Street 1:2526 W BIRCHWOOD AVE
Practice Address - Street 2:UNIT # A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-1666
Practice Address - Country:US
Practice Address - Phone:773-387-4997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)