| Organization Name: | JEHANGIR MISTRY |
| NPI Number: | 1124392139 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEHANGIR MISTRY (OWNER) |
| Mailing Address: | 2535 Bethany Rd Sycamore |
| State: | IL US |
| Postal Code: | 601783126 |
| Phone Number: | 8157566611 |
| Fax Number: | 8157568441 |
| NPI Enumeration Date: | 03/08/2012 |
| NPI Last Update Date: | 03/08/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 036054240 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |