Organization Active NPI

Mahesh K Agarwal MD SC

  • Pulmonary Disease Physician
  • Gurnee, IL
National Provider Identifier
1629065057
Registry record updated Jan 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
036044722 Issued in IL
Legal business name
MAHESH K AGARWAL MD SC
Practice address
200 S Greenleaf St
Suite G
Gurnee, IL 60031-3398
Phone
(847) 662-5100
Fax
(847) 662-5112
NPI assigned
Sep 30, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mahesh K Agrawal, MD
Title
President
Phone
(847) 662-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RP1001X 036044722 IL Primary

Addresses

Primary practice location

200 S Greenleaf St
Suite G
Gurnee, IL 60031-3398

Mailing address

200 S Greenleaf St
Suite G
Gurnee, IL 60031-3398
Phone (847) 662-5100

Other identifiers 1

IdentifierTypeStateIssuer
036044722MedicaidIL

National Provider Directory

National Provider Directory

Locations

200 S Greenleaf St
Ste G
Gurnee, IL 60031
Phone (847) 263-6073

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264723200000",
    "number": "1629065057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S GREENLEAF ST",
            "address_2": "SUITE G",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600313398",
            "telephone_number": "847-662-5100",
            "fax_number": "847-662-5112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S GREENLEAF ST",
            "address_2": "SUITE G",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600313398",
            "telephone_number": "847-662-5100",
            "fax_number": "847-662-5112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAHESH K AGARWAL MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-30",
        "last_updated": "2010-01-29",
        "status": "A",
        "authorized_official_last_name": "AGRAWAL",
        "authorized_official_first_name": "MAHESH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-662-5100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IL",
            "license": "036044722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036044722",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gurnee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.