Individual
DR. GAURAV SURESH MEHTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1027 WASHINGTON AVENUE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
Mailing address
400 E THIRD STREET, DULUTH, MN 55805-1951
(218) 847-5611
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
64848
MN
207Q00000X
Family Medicine Physician
BP10058334
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/21/2011
Last updated
04/03/2019
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