Provider Demographics
NPI:1316119571
Name:TALATI, MIHIR UMESH (MD)
Entity type:Individual
Prefix:DR
First Name:MIHIR
Middle Name:UMESH
Last Name:TALATI
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 1:3737 ECHO TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3434
Mailing Address - Country:US
Mailing Address - Phone:817-386-2020
Mailing Address - Fax:
Practice Address - Street 1:1905 DOCTORS HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2260
Practice Address - Country:US
Practice Address - Phone:940-683-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine