Healthcare Provider Details

I. General information

NPI: 1114960309
Provider Name (Legal Business Name): SATISH R MEHTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21501 KELLY RD
EASTPOINTE MI
48021-3213
US

IV. Provider business mailing address

3681 ACORN DR
TROY MI
48083-5793
US

V. Phone/Fax

Practice location:
  • Phone: 586-776-4185
  • Fax: 586-776-4185
Mailing address:
  • Phone: 313-868-7700
  • Fax: 586-776-5132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301065258
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: