Provider Demographics
NPI:1437185709
Name:MUKHERJEE & MUKAYED MDS PA
Entity Type:Organization
Organization Name:MUKHERJEE & MUKAYED MDS PA
Other - Org Name:MUKHERJEE & MUKAYED MDS PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:USAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKAYED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-521-4995
Mailing Address - Street 1:5800 49TH ST N STE 204
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2100
Mailing Address - Country:US
Mailing Address - Phone:727-521-4995
Mailing Address - Fax:727-289-3420
Practice Address - Street 1:5800 49TH ST N STE 204
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2100
Practice Address - Country:US
Practice Address - Phone:727-521-4995
Practice Address - Fax:727-289-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0000X
FLME51285207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061768700Medicaid
FL97866OtherBCBS
FLCC6463OtherRAILROAD MEDICARE
FL97866OtherBCBS
FLE56175Medicare UPIN
FL061768700Medicaid
FL04452XMedicare PIN