Basic Information
| Provider Information | |||||||||
| NPI: | 1821030750 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MISTRY | ||||||||
| FirstName: | ARVINDKUMAR | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4235 SECOR RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436234231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199479532 | ||||||||
| FaxNumber: | 4194795593 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 NAVARRE AVE | ||||||||
| Address2: | |||||||||
| City: | OREGON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436163207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196967701 | ||||||||
| FaxNumber: | 4196967866 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 05/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35052484 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 1939500-10 | 05 | MI | MEDICAID | 000000130435 | 01 | OH | BCBS | OTHER | 0605787 | 05 | OH | MEDICAID |