Provider Demographics
NPI:1427043827
Name:MEHTA, RAJNIKANT LILADHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJNIKANT
Middle Name:LILADHAR
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 1:315 MAIN ST S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3956
Mailing Address - Country:US
Mailing Address - Phone:701-839-6664
Mailing Address - Fax:701-839-1190
Practice Address - Street 1:315 MAIN ST S
Practice Address - Street 2:SUITE 102
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3956
Practice Address - Country:US
Practice Address - Phone:701-839-6664
Practice Address - Fax:701-839-1190
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4629208100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13955Medicaid
ND13955Medicaid
NDN865Medicare PIN
ND0428970001Medicare NSC