Provider Demographics
NPI:1699705491
Name:MEHROTRA, AVANTI (MD)
Entity type:Individual
Prefix:DR
First Name:AVANTI
Middle Name:
Last Name:MEHROTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 W BROADWAY AVE
Mailing Address - Street 2:SUITE 1135
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2969
Mailing Address - Country:US
Mailing Address - Phone:763-520-7887
Mailing Address - Fax:763-520-1131
Practice Address - Street 1:3435 W BROADWAY AVE
Practice Address - Street 2:SUITE 1135
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2969
Practice Address - Country:US
Practice Address - Phone:763-520-7887
Practice Address - Fax:763-520-1131
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIAM076386207RH0003X
MN52606207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5852710001Medicare NSC