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NPI Code Detail

MEDICARE: DR. MUKTIRAJ MEHTA M.D.

MEDICARE: DR. MUKTIRAJ MEHTA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician4301038926MI

General Provider Information

NPI Number : 1588658017
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MUKTIRAJ MEHTA M.D.
Provider Business Mailing Address
First Line : 960 E STATE ST
Second Line :
City : CASSOPOLIS
State : MI
Zip : 49031-9339
Country : US
Telephone Number : 269-445-2451
Fax Number : 269-445-3216
Provider Business Practice Location Address
First Line : 960 E STATE ST
Second Line :
City : CASSOPOLIS
State : MI
Zip : 49031-9339
Country : US
Telephone Number : 269-445-2451
Fax Number : 269-445-3216
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2005
Last Update Date : 11/02/2007

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