Healthcare Provider Details

I. General information

NPI: 1861420960
Provider Name (Legal Business Name): VIRENDRA SINHA MEHTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
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: 313-278-2720
Mailing address:
  • Phone: 248-842-7913
  • Fax: 313-278-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberVM033435
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberVM033435
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberVM033435
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberVM033435
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: