Provider Demographics
NPI:1710990908
Name:MEHTA, SAMEER (MD,FACC,MBA)
Entity Type:Individual
Prefix:DR
First Name:SAMEER
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD,FACC,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 SHORE DR S
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2615
Mailing Address - Country:US
Mailing Address - Phone:305-285-4171
Mailing Address - Fax:305-856-2351
Practice Address - Street 1:185 SHORE DR S
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2615
Practice Address - Country:US
Practice Address - Phone:305-860-2843
Practice Address - Fax:305-856-2351
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057724207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372462000Medicaid
FL14695Medicare PIN
E20333Medicare UPIN