Provider Demographics
NPI:1770549099
Name:MEHTA, RAJENDRA H (MD)
Entity type:Individual
Prefix:MR
First Name:RAJENDRA
Middle Name:H
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:306 W WASHINGTON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2141
Mailing Address - Country:US
Mailing Address - Phone:517-435-0260
Mailing Address - Fax:517-435-0261
Practice Address - Street 1:306 W WASHINGTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2141
Practice Address - Country:US
Practice Address - Phone:517-435-0260
Practice Address - Fax:517-435-0261
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRM068733207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4769501Medicaid
G26954Medicare UPIN
MI4769501Medicaid