MEDICARE: MUKESH H MEHTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	ME0064242	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689644304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUKESH H MEHTA MD

Provider Business Mailing Address
First Line	:	PO BOX 12160
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34603-2160
Country	:	US
Telephone Number	:	352-754-7222
Fax Number	:	352-754-7224

Provider Business Practice Location Address
First Line	:	7141 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-1048
Country	:	US
Telephone Number	:	352-754-7222
Fax Number	:	352-754-7224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	05/14/2020

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