Healthcare Provider Details

I. General information

NPI: 1427089309
Provider Name (Legal Business Name): VIKRAM P MEHTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4106 W. LAKE MARY BLVD SUITE 224
LAKE MARY FL
32746
US

IV. Provider business mailing address

4106 W. LAKE MARY BLVD SUITE 224
LAKE MARY FL
32746
US

V. Phone/Fax

Practice location:
  • Phone: 407-333-4548
  • Fax: 407-333-1797
Mailing address:
  • Phone: 407-333-4548
  • Fax: 407-333-1797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberME0055612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: