1639123029 NPI number — MITALI GOYAL M.D.

Table of content: MITALI GOYAL M.D. (NPI 1639123029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639123029 NPI number — MITALI GOYAL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOYAL
Provider First Name:
MITALI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639123029
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3751 MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 600. PO BOX 313
Provider Business Mailing Address City Name:
THE COLONY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75056-3866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-537-5813
Provider Business Mailing Address Fax Number:
866-779-1998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
328 W MAIN ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75057-3866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-537-5813
Provider Business Practice Location Address Fax Number:
972-755-6786
Provider Enumeration Date:
05/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  Q8491 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 11288 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100508628 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110508628 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104663 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".