Healthcare Provider Details

I. General information

NPI: 1487814653
Provider Name (Legal Business Name): KAUTILYA A MEHTA MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NW 9TH ST
OKLAHOMA CITY OK
73102-1068
US

IV. Provider business mailing address

608 NW 9TH ST
OKLAHOMA CITY OK
73102-1068
US

V. Phone/Fax

Practice location:
  • Phone: 405-232-2178
  • Fax: 405-232-6617
Mailing address:
  • Phone: 405-232-2178
  • Fax: 405-232-6617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number12793
License Number StateOK

VIII. Authorized Official

Name: DR. KAUTILYA A MEHTA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 405-232-2178