Individual
VIKAS MEHTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-6262
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 657-5000
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
205688
LA
207Y00000X
Otolaryngology Physician
245287
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2310127
—
LA
01
—
248301YH54
MEDICARE - PTAN
LA
Enumeration date
08/05/2007
Last updated
03/08/2013
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