Active NPI
Nandan Janakkumar Mehta
- Physical Therapist
- Lincoln Park, MI
National Provider Identifier
1538799218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501014280
- Practice address
- 25880 W Outer Drive
Lincoln Park, MI 48146-1553 - Phone
- (313) 389-5200
- NPI assigned
- Jan 22, 2020
- Last updated
- Jun 2, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501014280 | MI | Primary |
Addresses
Primary practice location
25880 W Outer Drive
Lincoln Park, MI 48146-1553
Mailing address
1643 Bayberry Park Cir
Canton, MI 48188-5248
Phone (734) 444-4826
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501014280 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654128000000",
"number": "1538799218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1643 BAYBERRY PARK CIR",
"city": "CANTON",
"state": "MI",
"postal_code": "481885248",
"telephone_number": "734-444-4826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25880 W OUTER DRIVE",
"city": "LINCOLN PARK",
"state": "MI",
"postal_code": "481461553",
"telephone_number": "313-389-5200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEHTA",
"first_name": "NANDAN",
"middle_name": "JANAKKUMAR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-01-22",
"last_updated": "2022-06-02",
"certification_date": "2022-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501014280",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lincoln Park, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.