Provider Demographics
NPI:1689644304
Name:MEHTA, MUKESH H (MD)
Entity Type:Individual
Prefix:
First Name:MUKESH
Middle Name:H
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:PO BOX 12160
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34603-2160
Mailing Address - Country:US
Mailing Address - Phone:352-754-7222
Mailing Address - Fax:352-754-7224
Practice Address - Street 1:7141 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-1048
Practice Address - Country:US
Practice Address - Phone:352-754-7222
Practice Address - Fax:352-754-7224
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0064242207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373731400Medicaid
FL18907Medicare ID - Type Unspecified
FL373731400Medicaid