Provider Demographics
NPI:1093707960
Name:KHANDUJA, KARAMJIT S (MD)
Entity Type:Individual
Prefix:
First Name:KARAMJIT
Middle Name:S
Last Name:KHANDUJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:K
Other - Middle Name:S
Other - Last Name:KHANDUJA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5965 E BROAD ST
Mailing Address - Street 2:#250
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1562
Mailing Address - Country:US
Mailing Address - Phone:614-759-5060
Mailing Address - Fax:614-759-5065
Practice Address - Street 1:5965 E BROAD ST
Practice Address - Street 2:#250
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1562
Practice Address - Country:US
Practice Address - Phone:614-759-5060
Practice Address - Fax:614-759-5065
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049486208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHD639090Medicaid
KH0587773Medicare ID - Type Unspecified
A82508Medicare UPIN