Healthcare Provider Details

I. General information

NPI: 1659681575
Provider Name (Legal Business Name): VIKRAM P MEHTA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4106 W LAKE MARY BLVD SUITE 224
LAKE MARY FL
32746-3315
US

IV. Provider business mailing address

4106 W LAKE MARY BLVD SUITE 224
LAKE MARY FL
32746-3315
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: RITA MEDINA
Title or Position: OFFICE MANAGER
Credential: MA
Phone: 407-333-4548