Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 35.122534 | OH |
Y | 207RA0401X | Internist - Addiction Medicine | 67258-20 | WI |
NPI | 1174890792 |
---|---|
Provider Name | Dr. Milind Mehta |
First Address | Wauwatosa, WI 53213-2504 |
Second Address | Wauwatosa, WI 53213-2504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2011 |
Last Update Date | 23/11/2021 |