Provider Demographics
NPI:1194981985
Name:MEHTA, ANKUR (MD)
Entity type:Individual
Prefix:
First Name:ANKUR
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9400 S SAGINAW RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9601
Mailing Address - Country:US
Mailing Address - Phone:810-487-4500
Mailing Address - Fax:810-991-8228
Practice Address - Street 1:8562 HOLLY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8301
Practice Address - Country:US
Practice Address - Phone:810-487-4500
Practice Address - Fax:810-991-8228
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036134244207W00000X
MI4301092731207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400140664Medicare PIN
MIMI6036002Medicare UPIN