Provider Demographics
NPI:1003961236
Name:KHAZANCHI, ARUN P (MD)
Entity Type:Individual
Prefix:MR
First Name:ARUN
Middle Name:P
Last Name:KHAZANCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ARUN
Other - Middle Name:P
Other - Last Name:KHAZANCHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11505 PALMBRUSH TRAIL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2904
Mailing Address - Country:US
Mailing Address - Phone:941-334-9040
Mailing Address - Fax:941-334-9030
Practice Address - Street 1:11505 PALMBRUSH TRAIL
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2904
Practice Address - Country:US
Practice Address - Phone:941-334-9040
Practice Address - Fax:941-334-9030
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86268207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8467ZMedicare ID - Type Unspecified
FLH09068Medicare UPIN