Provider Demographics
NPI:1396716536
Name:MEHTA, STEVEN S (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:S
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 1:3424 RED LEAF LN
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-8108
Mailing Address - Country:US
Mailing Address - Phone:602-432-6876
Mailing Address - Fax:
Practice Address - Street 1:7700 E FLORENTINE RD
Practice Address - Street 2:STE 206
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2245
Practice Address - Country:US
Practice Address - Phone:928-442-8117
Practice Address - Fax:928-772-8947
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19661207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
060054990OtherRAILROAD MEDICARE
AZ138851Medicaid
AZAZ0844050OtherBLUE CROSS
606654990OtherRAILROAD MEDICARE
AZAZ0844050OtherBLUE CROSS
AZZ61916Medicare PIN