Basic Information
| Provider Information | |||||||||
| NPI: | 1730160946 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEHTA | ||||||||
| FirstName: | YASHBIR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 379 | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604620379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084609833 | ||||||||
| FaxNumber: | 7084601117 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 N GREENLEAF ST | ||||||||
| Address2: | |||||||||
| City: | GURNEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600313309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476232114 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 036044625 | IL | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 01633381 | 01 | IL | BCBSIL ADVANCED RAD | OTHER | 1548251986 | 01 | ADV RAD NPI # | OTHER | 04932214 | 01 | IL | BCBSIL ROTATING GAMMA | OTHER | 1902897358 | 01 | ROT GMA NPI# | OTHER | 920007667 | 01 | IL | RR MEDICARE ADVANCED RAD | OTHER | P00042095 | 01 | IL | RR MEDICARE ROT GMA | OTHER | CK9135 | 01 | IL | RR MEDICARE ADV RAD GR# | OTHER | 036044625 | 05 | IL | MEDICAID | DA2626 | 01 | IL | RR MEDICARE ROT GMA GR# | OTHER |