Provider Demographics
NPI:1508854787
Name:MEHTA, GIRISH HIMATLAL (MD)
Entity Type:Individual
Prefix:
First Name:GIRISH
Middle Name:HIMATLAL
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13634 NORTH 93RD AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381
Mailing Address - Country:US
Mailing Address - Phone:623-933-0301
Mailing Address - Fax:623-933-0224
Practice Address - Street 1:13634 NORTH 93RD AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:623-933-0301
Practice Address - Fax:623-933-0224
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ18499207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ18499OtherSTATE LICENSE
AZ18499OtherSTATE LICENSE
F20553Medicare UPIN
WMBRQ01Medicare ID - Type Unspecified