BRINDA MUKESH MEHTA (NPI# 1205195849) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205195849 |
| Entity Type | Individual |
| Full Name | BRINDA MUKESH MEHTA |
| Credential | M.D. |
| Practice Address |
530 Ne Glen Oak Ave Uicomp/dept. of Pediatrics Osf North Bldg. Room 5642 Peoria IL 61637 |
| Mailing Address |
530 Ne Glen Oak Avenue Uicomp Dept of Pediatrics, Osf North Bldg. Room 5642 Peoria IL 61637 |
| Practice Telephone | 3096554746 |
| Practice Fax Number | 3096552565 |
| Mailing Telephone | 3096554746 |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0207X |
Pediatrics Specialization: Pediatric Hematology-Oncology |
036.142777 | IL | Allopathic & Osteopathic Physicians |
| N | 2080P0207X |
Pediatrics Specialization: Pediatric Hematology-Oncology |
01074184A | IN | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | BP10039198 | TX | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 40 Sunshine Cottage Rd, Skyline Drive, Room Number 1n-j08, Valhalla, NY 105951524 | 3618779383 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720411150 | Brinda Mehta | Occupational Therapist | 3974 Nw 82nd Dr, Pembroke Pines, FL 33024-3567 | 2013-08-21 |
| Street Address |
530 NE GLEN OAK AVE UICOMP/DEPT. OF PEDIATRICS OSF NORTH BLDG. ROOM 5642 |
| City | PEORIA |
| State | IL |
| Zip Code | 61637 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346235777 | Jack Michael Gibson | Obstetrics & Gynecology | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2005-09-12 |
| 1053912188 | Janie Clary | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-11-04 |
| 1265030548 | Christina David | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-10-09 |
| 1033726831 | Corry Lynn Rediger | Occupational Therapist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-09-25 |
| 1720694094 | Katelynn M Madden | Clinical Nurse Specialist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-09-21 |
| 1568074474 | Amanda Diane Beoletto | Pharmacist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-08-21 |
| 1881212892 | Mohammad Mousbah Al-tabbaa | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-07-07 |
| 1750909693 | Mohammad Gareeb | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-07-07 |
| 1376160846 | Bassel Elia Abouzeid | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637 | 2020-07-01 |
| 1700403516 | Christina Marie Spurgeon | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-06-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780200865 | Kuang Chuen Liu | Pediatrics | 530 Ne Glen Oak Ave, Peoria, Peoria, IL 61637 | 2020-06-24 |
| 1174184527 | Manisha Tharoor | Student in an Organized Health Care Education/Training Program | 530 N.e Glen Oak Ave, Peoria, IL 61637 | 2019-06-26 |
| 1609436724 | Sriviji Senthil Kumaran | Student in an Organized Health Care Education/Training Program | 530. N.e Glen Oak Ave., Peoria, IL 61637 | 2019-06-20 |
| 1780240929 | Abuzar Ali Asif | Student in an Organized Health Care Education/Training Program | 530 N. E. Glen Oak Ave., Peoria, IL 61637 | 2019-05-14 |
| 1518328665 | Jenna Bishop | Dietitian, Registered | 600 Ne Water Street, Peoria, IL 61637 | 2016-03-17 |
| 1194133850 | Ashish Kumar Roy | Internal Medicine | 530 N.e. Glen Oak Ave, Peoria, IL 61637 | 2014-07-25 |
| 1265720510 | Reuben Antony | Pediatrics | 530 Ne Glen Oak Ave., C/o Ms Suzy Lewellen, Peoria, IL 61637 | 2011-07-20 |
| 1366673436 | Joseph William Hauter | Emergency Medicine | 830 Ne Glen Oak Ave, Peoria, IL 61637 | 2009-08-06 |
| 1437380748 | Jeremy R Monroe | Emergency Medicine | 530 Glen Oak, Osf St Francis Medical Center, Peoria, IL 61637 | 2009-08-04 |
| 1326244682 | Maria S. Parr | Psychiatry & Neurology | Osf Saint Francis Medical Center, 530 N.e.glen Oak Ave., Peoria, FL 61637 | 2007-06-25 |
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| Taxonomy Code | 2080P0207X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Hematology-Oncology |
| A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous diseases. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265720510 | Reuben Antony | Pediatrics | 530 Ne Glen Oak Ave., C/o Ms Suzy Lewellen, Peoria, IL 61637 | 2011-07-20 |
| 1568433050 | University of Illinois | Pediatrics | St Jude Midwest Affiliate, 530 Ne Glen Oak, Peoria, IL 61637-0001 | 2006-02-01 |
| 1396731063 | Michael D Tarantino | Pediatrics | 9128 N Lindbergh Dr, Peoria, IL 61615-1422 | 2005-09-27 |
| 1841293032 | Pedro A De Alarcon | Pediatrics | Children's Hospital of Illinois 530 Ne Glen Oak Ave, Peoria, IL 61637 | 2005-05-23 |
| 1740430784 | Michael D. Tarantino, M.d. S.c. | Pediatrics | 6811 N Knoxville Ave, Suite A, Peoria, IL 61614-2861 | 2008-09-26 |
| 1558339978 | Kay Saving | Pediatrics | St Jude Midwest Affiliate, 530 Ne Glen Oak, Peoria, IL 61637-0001 | 2006-03-10 |
| 1841287588 | Mary Elizabeth Ross | Pediatrics | 530 Ne Glen Oak Ave, Peoria, IL 61637 | 2005-09-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780829911 | Richard Moldwin | Pediatrics | 9017 Ewing Ave, Evanston, IL 60203-1908 | 2008-12-02 |
| 1801005848 | Marie-ellen Tubal Sarvida | Pediatrics | 4440 West 95th Street, Oak Lawn, IL 60453 | 2007-05-22 |
| 1639395304 | Lenore Evans Gonzalez | Pediatrics | 236 S 5th St, Apt C, Springfield, IL 62701-1431 | 2007-04-18 |
| 1700948643 | Astrid K. Mack | Pediatrics | 2300 N Childrens Plz # 30, Chicago, IL 60614-3363 | 2006-12-15 |
| 1659449163 | Pediatric Cancer Institute | Pediatrics | 4440 W.95th Street, Oak Lawn, IL 60453 | 2006-12-01 |
| 1699724385 | Joanna Lynn Weinstein | Pediatrics | 2300 Childrens Plaza Box 30, Childrens Memorial Hospital Hem Onc, Chicago, IL 60614 | 2006-05-09 |
| 1427051622 | John M Cunningham | Pediatrics | 5841 South Maryland Ave, University of Chicago Rm N-112 Mc 4060, Chicago, IL 60637 | 2005-05-23 |
| 1053958173 | Anna Kathryn Person | Pediatrics | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2019-12-09 |
| 1891189221 | Lindsay Schwartz | Pediatrics | 5841 S Maryland Ave # Mc4060, Chicago, IL 60637-1443 | 2015-03-24 |
| 1639599475 | Katherine Marie Harris | Pediatrics | 5841 S Maryland Ave # Mc4060, Chicago, IL 60637-1443 | 2014-04-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.