Provider Demographics
NPI:1518161199
Name:MEHTA, ANKUR KISHOR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANKUR
Middle Name:KISHOR
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 1:109 N HALL DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3861
Mailing Address - Country:US
Mailing Address - Phone:281-935-9282
Mailing Address - Fax:
Practice Address - Street 1:1327 LAKE POINTE PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4095
Practice Address - Country:US
Practice Address - Phone:281-242-8463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-00269142086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
3872487439OtherMYUTMB 3872487439-COMMERCIAL NUMBER