Provider Demographics
NPI:1700077252
Name:MITTAL, RICHA (MD)
Entity type:Individual
Prefix:
First Name:RICHA
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 1:3550 PARKWOOD BLVD STE 702
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1920
Mailing Address - Country:US
Mailing Address - Phone:469-294-3501
Mailing Address - Fax:337-210-7623
Practice Address - Street 1:3550 PARKWOOD BLVD STE 702
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1920
Practice Address - Country:US
Practice Address - Phone:469-294-3501
Practice Address - Fax:337-210-7623
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6498207R00000X, 207RB0002X
TN42385208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000644Medicaid
7100019730OtherKENTUCKY MEDICAID
TN4163890OtherBCBS
9133089OtherAETNA
TN4338656OtherBLUECROSS BLUESHIELD
TX220528801Medicaid
P00440239OtherRAILROAD MEDICARE
TN103I112772Medicare PIN
9133089OtherAETNA
TN4163890OtherBCBS