Provider Demographics
NPI:1801899604
Name:MEHTA, PRAFUL CHANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:PRAFUL
Middle Name:CHANDRA
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3730 N RIDGE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1228
Mailing Address - Country:US
Mailing Address - Phone:316-462-6200
Mailing Address - Fax:316-462-6214
Practice Address - Street 1:3730 N RIDGE RD
Practice Address - Street 2:STE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1228
Practice Address - Country:US
Practice Address - Phone:316-462-6200
Practice Address - Fax:316-462-6214
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0423395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100768Medicare ID - Type UnspecifiedPROVIDER NUMBER
KSF36381Medicare UPIN