Healthcare Provider Details

I. General information

NPI: 1013014133
Provider Name (Legal Business Name): SANJIV MEHTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 NEW SHEPHERDSVILLE RD
BARDSTOWN KY
40004-8040
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 502-348-5685
  • Fax: 502-331-4361
Mailing address:
  • Phone: 606-330-7835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number30440
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number30440
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: