Provider Demographics
NPI:1639123029
Name:GOYAL, MITALI (MD)
Entity Type:Individual
Prefix:
First Name:MITALI
Middle Name:
Last Name:GOYAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3751 MAIN STREET
Mailing Address - Street 2:SUITE 600. PO BOX 313
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-3866
Mailing Address - Country:US
Mailing Address - Phone:972-537-5813
Mailing Address - Fax:866-779-1998
Practice Address - Street 1:328 W MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3866
Practice Address - Country:US
Practice Address - Phone:972-537-5813
Practice Address - Fax:972-755-6786
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8491207R00000X
NV11288207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508628Medicaid
NV110508628Medicaid
NV104663OtherMEDICARE PTAN
NV100508628Medicaid
NV110508628Medicaid
NVGM387YMedicare PIN