Healthcare Provider Details

I. General information

NPI: 1235307380
Provider Name (Legal Business Name): VIRENDRA S MEHTA MD FRCS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 TELEGRAPH RD
TAYLOR MI
48180-3330
US

IV. Provider business mailing address

47493 BLUE HERON CT
NORTHVILLE MI
48168-8823
US

V. Phone/Fax

Practice location:
  • Phone: 248-842-7913
  • Fax: 313-295-5315
Mailing address:
  • Phone: 248-842-7913
  • Fax: 586-649-7391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: VIRENDRA SINHA MEHTA
Title or Position: PRESIDENT
Credential: MD
Phone: 248-842-7913