Provider Demographics
NPI:1699783696
Name:MEHTA, NIMISHA APURVA (MD)
Entity type:Individual
Prefix:
First Name:NIMISHA
Middle Name:APURVA
Last Name:MEHTA
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 1:860 HEBRON PKWY
Mailing Address - Street 2:SUITE #401
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5151
Mailing Address - Country:US
Mailing Address - Phone:469-916-6641
Mailing Address - Fax:469-322-4175
Practice Address - Street 1:860 HEBRON PKWY
Practice Address - Street 2:SUITE #401
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5151
Practice Address - Country:US
Practice Address - Phone:469-916-6641
Practice Address - Fax:469-322-4175
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8CE217OtherBLUE CROSS BLUE SHIELD
TX1633380Medicaid
H98730Medicare UPIN
8D9888Medicare ID - Type Unspecified
TX1633380Medicaid