Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 30440 | KY |
NPI | 1013014133 |
---|---|
Provider Name | Sanjiv Mehta |
First Address | Louisville, KY 40229-2182 |
Second Address | Bardstown, KY 40004-3265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 04/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G71558 | (02) | KY |