Provider Demographics
NPI:1679582803
Name:KHANNA, NITIN (MD)
Entity Type:Individual
Prefix:DR
First Name:NITIN
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 3329
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3329
Mailing Address - Country:US
Mailing Address - Phone:219-924-3300
Mailing Address - Fax:219-934-2658
Practice Address - Street 1:730 45TH STREET
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2818
Practice Address - Country:US
Practice Address - Phone:219-924-3300
Practice Address - Fax:219-934-2658
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057387A207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000104771OtherANTHEM GROUP
IL61560247Medicaid
CI3318OtherRRMEDICARE GROUP
7873468OtherAETNA DR KHANNA
IL001051714OtherBCIL KHANNA
129555400OtherUS DEPT LABOR GROUP
IN200135850AOtherMEDICAID IN GROUP
901926OtherUNITED HLTHCARE DR KHANNA
140220OtherMEDICARE GROUP SMMN
9000692OtherBCIL GROUP
IN000000293387OtherANTHEM KHANNA
2080835OtherFIRST HEALTH DR KHANNA
IN874640OtherMEDICARE GROUP
IN000000104771OtherANTHEM GROUP
IN200135850AOtherMEDICAID IN GROUP
2080835OtherFIRST HEALTH DR KHANNA
1170000002Medicare NSC
P00017026Medicare PIN