Provider Demographics
NPI:1407865322
Name:KHANDEKAR, ALIM (M D)
Entity Type:Individual
Prefix:
First Name:ALIM
Middle Name:
Last Name:KHANDEKAR
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT # 457
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-758-7888
Mailing Address - Fax:901-302-2445
Practice Address - Street 1:1251 WESLEY DR
Practice Address - Street 2:SUITE 151
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6442
Practice Address - Country:US
Practice Address - Phone:901-758-7888
Practice Address - Fax:901-302-2445
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10427208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6005703OtherBCBS
TNP01288702OtherRAILROAD MEDICARE
AR110767001Medicaid
TN1506167Medicaid
MS00014625Medicaid
TN103I338198Medicare PIN