Provider Demographics
NPI:1346439734
Name:VIJAY G MISTRY MD INC
Entity Type:Organization
Organization Name:VIJAY G MISTRY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MISTRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-442-2040
Mailing Address - Street 1:PO BOX 22723
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-0723
Mailing Address - Country:US
Mailing Address - Phone:440-442-2040
Mailing Address - Fax:440-460-2807
Practice Address - Street 1:6770 MAYFIELD RD # 425
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2299
Practice Address - Country:US
Practice Address - Phone:440-442-2040
Practice Address - Fax:440-460-2807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081884207R00000X
OH35042001207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0432928Medicaid
OH2448067Medicaid
OH2524852Medicaid
OHH89950Medicare UPIN
OHA79225Medicare UPIN
OH2524852Medicaid
OH0711063Medicare PIN
OH0432928Medicaid
OH9258391Medicare PIN
OH0711064Medicare PIN
OH2448067Medicaid