Healthcare Provider Details

I. General information

NPI: 1760442693
Provider Name (Legal Business Name): HEMALINI MEHTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NICOLLET MALL SUITE 1149
MINNEAPOLIS MN
55402-2606
US

IV. Provider business mailing address

825 NICOLLET MALL SUITE 1149
MINNEAPOLIS MN
55402-2606
US

V. Phone/Fax

Practice location:
  • Phone: 612-338-3333
  • Fax: 612-349-3838
Mailing address:
  • Phone: 612-338-3333
  • Fax: 612-349-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number44017
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: