Healthcare Provider Details

I. General information

NPI: 1477168607
Provider Name (Legal Business Name): RAJENDRA MEHTA, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W WASHINGTON AVE STE 102
JACKSON MI
49201-2141
US

IV. Provider business mailing address

306 W WASHINGTON AVE STE 102
JACKSON MI
49201-2141
US

V. Phone/Fax

Practice location:
  • Phone: 517-744-5112
  • Fax:
Mailing address:
  • Phone: 517-744-5112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: REJENDRA MEHTA
Title or Position: DOCTOR
Credential: MD
Phone: 517-435-0260