Provider Demographics
NPI:1225045735
Name:MEHTA, NILESH SHIRISH (MD)
Entity Type:Individual
Prefix:DR
First Name:NILESH
Middle Name:SHIRISH
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6065 MONTANA AVE
Mailing Address - Street 2:STE C10
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1835
Mailing Address - Country:US
Mailing Address - Phone:915-540-7070
Mailing Address - Fax:888-822-3363
Practice Address - Street 1:6065 MONTANA AVE
Practice Address - Street 2:STE C10
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1835
Practice Address - Country:US
Practice Address - Phone:915-540-7070
Practice Address - Fax:888-822-3363
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2681207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085780701Medicaid
TX0A5550OtherMEDICARE GROUP
TX123380101Medicaid
TX085780701Medicaid
TX0A5550OtherMEDICARE GROUP