Provider Demographics
NPI:1346472362
Name:NIMISHA MEHTA MD PA
Entity Type:Organization
Organization Name:NIMISHA MEHTA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIMISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-916-6641
Mailing Address - Street 1:860 HEBRON PKWY STE 401
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5143
Mailing Address - Country:US
Mailing Address - Phone:469-916-6641
Mailing Address - Fax:469-322-4175
Practice Address - Street 1:860 HEBRON PKWY STE 401
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5143
Practice Address - Country:US
Practice Address - Phone:469-916-6641
Practice Address - Fax:469-322-4175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0084SVOtherBLUE CROSS BLUE SHIELD
0084SVOtherBLUE CROSS BLUE SHIELD