Provider Demographics
NPI:1609078385
Name:MUKHERJEE, INDRANI (MBCHB)
Entity Type:Individual
Prefix:
First Name:INDRANI
Middle Name:
Last Name:MUKHERJEE
Suffix:
Gender:F
Credentials:MBCHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 BELFORT ROAD
Mailing Address - Street 2:SUITE 4020
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1475
Mailing Address - Country:US
Mailing Address - Phone:904-450-6444
Mailing Address - Fax:904-296-9542
Practice Address - Street 1:425 NORTH LEE STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-1128
Practice Address - Country:US
Practice Address - Phone:904-354-8200
Practice Address - Fax:904-354-1340
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN50082207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00405215OtherMEDICARE RAILROAD
MN505467000Medicaid
MN505467000Medicaid