Provider Demographics
NPI:1831311851
Name:MEHTA, FALGUNI N (MD)
Entity Type:Individual
Prefix:
First Name:FALGUNI
Middle Name:N
Last Name:MEHTA
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 1:4480 UTICA RIDGE RD
Mailing Address - Street 2:SUITE 2236
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1656
Mailing Address - Country:US
Mailing Address - Phone:563-742-5850
Mailing Address - Fax:563-742-5855
Practice Address - Street 1:4480 UTICA RIDGE RD
Practice Address - Street 2:SUITE 2236
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1656
Practice Address - Country:US
Practice Address - Phone:563-742-5850
Practice Address - Fax:563-742-5855
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37813207Q00000X
IAR-7965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1831311851Medicaid
IA1831311851Medicaid