Provider Demographics
NPI:1053425801
Name:MEHTA, ANJALI J (MD)
Entity type:Individual
Prefix:DR
First Name:ANJALI
Middle Name:J
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 1:1200 N WEST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2179
Mailing Address - Country:US
Mailing Address - Phone:517-780-3332
Mailing Address - Fax:517-796-4532
Practice Address - Street 1:1200 N WEST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2179
Practice Address - Country:US
Practice Address - Phone:517-780-3332
Practice Address - Fax:517-796-4532
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0471232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI260C876120OtherBLUE CROSS BLUE SHIELD
MI2774567Medicaid
MI260C876120OtherBLUE CROSS BLUE SHIELD
MIE49670Medicare UPIN