Healthcare Provider Details

I. General information

NPI: 1588678122
Provider Name (Legal Business Name): ROHAAN F. MEHTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 03/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 OAKDALE AVE N COMPREHENSIVE PAIN MANAGEMENT CLINIC
ROBBINSDALE MN
55422
US

IV. Provider business mailing address

3300 OAKDALE AVE N COMPREHENSIVE PAIN MANAGEMENT CLINIC
ROBBINSDALE MN
55422-2926
US

V. Phone/Fax

Practice location:
  • Phone: 763-581-3680
  • Fax:
Mailing address:
  • Phone: 763-581-3680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number50067
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number50067
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: