Provider Demographics
NPI:1710270608
Name:KHANNA, MUKUL KRISHAN (MD)
Entity Type:Individual
Prefix:
First Name:MUKUL
Middle Name:KRISHAN
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 940145
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-0145
Mailing Address - Country:US
Mailing Address - Phone:407-915-5643
Mailing Address - Fax:407-960-2602
Practice Address - Street 1:251 MAITLAND AVE STE 116
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4913
Practice Address - Country:US
Practice Address - Phone:407-915-5643
Practice Address - Fax:407-960-2602
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120684207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine