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NPI Code Detail

MEDICARE: DR. SUDEEP KIRTIKUMAR MEHTA M.D.

MEDICARE: DR. SUDEEP KIRTIKUMAR 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
1208100000XPhysical Medicine & Rehabilitation Physician83806SC
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1912353400
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUDEEP KIRTIKUMAR MEHTA M.D.
Provider Business Mailing Address
First Line : 2475 HILLCREST CENTER CIR
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-3048
Country : US
Telephone Number : 843-792-6200
Fax Number :
Provider Business Practice Location Address
First Line : 2475 HILLCREST CENTER CIR
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-3048
Country : US
Telephone Number : 336-754-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2016
Last Update Date : 02/25/2026

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