Provider Demographics
NPI:1447309919
Name:MITTAL, DEEPA (MD)
Entity type:Individual
Prefix:
First Name:DEEPA
Middle Name:
Last Name:MITTAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DELL SETON MEDICAL CENTER AT THE UNIVERSITY OF TEXAS
Mailing Address - Street 2:1500 RED RIVER STREET
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701
Mailing Address - Country:US
Mailing Address - Phone:512-324-7863
Mailing Address - Fax:
Practice Address - Street 1:DELL SETON MEDICAL CENTER AT THE UNIVERSITY OF TEXAS
Practice Address - Street 2:1500 RED RIVER STREET
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701
Practice Address - Country:US
Practice Address - Phone:512-324-7863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3023207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148604502Medicaid
TX148604502Medicaid
TX8D9045Medicare ID - Type Unspecified
TX8F4338Medicare PIN
TX00X222Medicare PIN