Provider Demographics
NPI:1598878456
Name:KHENGAR, NARENDRA R (MD)
Entity Type:Individual
Prefix:
First Name:NARENDRA
Middle Name:R
Last Name:KHENGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 NO MORE VICTIMS RD
Mailing Address - Street 2:J.C.C.C.
Mailing Address - City:JEFFERSON CTY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-4539
Mailing Address - Country:US
Mailing Address - Phone:573-751-3224
Mailing Address - Fax:573-761-0305
Practice Address - Street 1:500 CARPATHIAN DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-0192
Practice Address - Country:US
Practice Address - Phone:573-445-4279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD106179207R00000X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8149414OtherCPIW
MO208284505Medicaid
110122136OtherRR
8149414OtherCPIW
110122136OtherRR