Provider Demographics
NPI:1740773852
Name:MISTRY, NUPUR SANGHAVI (MD)
Entity type:Individual
Prefix:
First Name:NUPUR
Middle Name:SANGHAVI
Last Name:MISTRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NUPUR
Other - Middle Name:BHAVYEN
Other - Last Name:SANGHAVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-3442
Mailing Address - Fax:503-494-5330
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-3442
Practice Address - Fax:503-494-5330
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD219832207RN0300X, 207R00000X
IL036.156978207RN0300X
IL125.072451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine