Provider Demographics
NPI:1326048190
Name:MEHTA, DAKSHA P (MD)
Entity Type:Individual
Prefix:
First Name:DAKSHA
Middle Name:P
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 1:584 WESTPORT RD
Mailing Address - Street 2:STE 101
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2987
Mailing Address - Country:US
Mailing Address - Phone:270-769-2535
Mailing Address - Fax:270-769-9020
Practice Address - Street 1:584 WESTPORT RD
Practice Address - Street 2:STE 101
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2987
Practice Address - Country:US
Practice Address - Phone:270-769-2535
Practice Address - Fax:270-769-9020
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2020-10-26
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
KY30757207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64307572Medicaid
E52630Medicare UPIN
KY0785301Medicare ID - Type Unspecified