Basic Information
| Provider Information | |||||||||
| NPI: | 1649633918 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KELTA | ||||||||
| FirstName: | MOUHAMMED | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 62647 COLLECTION CENTER DR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606930626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084784302 | ||||||||
| FaxNumber: | 7082651724 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ANDREW CT | ||||||||
| Address2: | |||||||||
| City: | BURR RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605278128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305609288 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2016 | ||||||||
| LastUpdateDate: | 09/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 036087250 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.