Provider Demographics
NPI:1194740381
Name:MEHTA, SAUMIL A (MD)
Entity type:Individual
Prefix:
First Name:SAUMIL
Middle Name:A
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6404 INTERNATIONAL PKWY STE 1010
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8346
Mailing Address - Country:US
Mailing Address - Phone:972-267-1988
Mailing Address - Fax:972-267-3434
Practice Address - Street 1:6404 INTERNATIONAL PKWY STE 1010
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8346
Practice Address - Country:US
Practice Address - Phone:972-267-1988
Practice Address - Fax:972-267-3434
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3013207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098858603Medicaid
TX098858604Medicaid
TX098858605Medicaid
TX8B6091Medicare PIN
TX8L26975Medicare PIN
TX098858604Medicaid
TXF44943Medicare UPIN