Basic Information
| Provider Information | |||||||||
| NPI: | 1194740381 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEHTA | ||||||||
| FirstName: | SAUMIL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6404 INTERNATIONAL PKWY STE 1010 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750938346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722671988 | ||||||||
| FaxNumber: | 9722673434 | ||||||||
| Practice Location | |||||||||
| Address1: | 6404 INTERNATIONAL PKWY STE 1010 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750938346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722671988 | ||||||||
| FaxNumber: | 9722673434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 02/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | J3013 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 098858603 | 05 | TX | MEDICAID | 098858604 | 05 | TX | MEDICAID | 098858605 | 05 | TX | MEDICAID |