Basic Information
| Provider Information | |||||||||
| NPI: | 1922202159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEHTA | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6682 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559036682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2184012187 | ||||||||
| FaxNumber: | 8323246927 | ||||||||
| Practice Location | |||||||||
| Address1: | WHITE EARTH MENTAL HEALTH CLINIC | ||||||||
| Address2: | 40520 COUNTY HIGHWAY 34 | ||||||||
| City: | OGEMA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2189836325 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 04/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 63813 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.