Provider Demographics
NPI:1003921552
Name:MEHTA, HEMANGINI J (MD)
Entity Type:Individual
Prefix:DR
First Name:HEMANGINI
Middle Name:J
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14050 NW 14TH ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2865
Mailing Address - Country:US
Mailing Address - Phone:303-386-3881
Mailing Address - Fax:954-424-3270
Practice Address - Street 1:14050 NW 14TH ST
Practice Address - Street 2:SUITE 190
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2865
Practice Address - Country:US
Practice Address - Phone:303-386-3881
Practice Address - Fax:954-424-3270
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39416207R00000X
FLME 0111801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64116783Medicaid
IN200897070Medicaid
IN200897070Medicaid
KY00546012Medicare Oscar/Certification
KYP00453184Medicare PIN