Provider Demographics
NPI:1245425503
Name:MITTAL, NAVNEET (MD)
Entity Type:Individual
Prefix:DR
First Name:NAVNEET
Middle Name:
Last Name:MITTAL
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:PO BOX 65057
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-5057
Mailing Address - Country:US
Mailing Address - Phone:210-299-8000
Mailing Address - Fax:210-561-6036
Practice Address - Street 1:12705 TOEPPERWEIN RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3257
Practice Address - Country:US
Practice Address - Phone:210-599-0922
Practice Address - Fax:210-599-2951
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0254207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX318012YPYROtherMEDICARE PTAN
TX74-2332650OtherTAX ID