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General NPI Number Information
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NPI Number | 1215200811
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Entity Type | Organization
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Legal Business Name | GOVIND K MEHTA, M.D., INC.
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Dates
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Enumeration Date | 02/14/2012
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Last Update Date | 03/29/2012
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Provider Practice Location Address
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Address Line | 125 E BROAD ST SUITE 322
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City | ELYRIA
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State | OH
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Zip | 44035-6400
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Country | US
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Telephone | 440-329-7345
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Fax | 440-329-7347
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Provider Business Mailing Address
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Address Line | 125 E BROAD ST SUITE 322
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City | ELYRIA
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State | OH
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Zip | 44035-6400
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Country | US
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Telephone | 440-329-7345
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Fax | 440-329-7347
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Authorized Official
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Title or Position | OWNER
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Name | DR. GOVINDRAM K MEHTA
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Credential | M.D.
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Telephone | 440-329-7345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 35049795
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License Number State | OH
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