Provider Demographics
NPI:1134512569
Name:MEHTA, RADHIKA (DO)
Entity Type:Individual
Prefix:MISS
First Name:RADHIKA
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 S LAPEER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-5039
Mailing Address - Country:US
Mailing Address - Phone:248-384-8320
Mailing Address - Fax:248-384-8321
Practice Address - Street 1:834 S LAPEER RD STE 100
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-5039
Practice Address - Country:US
Practice Address - Phone:248-384-8320
Practice Address - Fax:248-384-8321
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101023521208000000X
MI5101026184207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics