Provider Demographics
NPI:1659705762
Name:KHANNA, PRADEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:PRADEEP
Middle Name:
Last Name:KHANNA
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:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-633-0610
Mailing Address - Fax:904-633-0611
Practice Address - Street 1:6015 118TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-3703
Practice Address - Country:US
Practice Address - Phone:904-633-0610
Practice Address - Fax:904-633-0611
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR020577208D00000X
FLACN514208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice