Provider Demographics
NPI:1790972511
Name:ANJALI KHERDEKAR PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:ANJALI KHERDEKAR PROFESSIONAL ASSOCIATION
Other - Org Name:ANJALI KHERDEKAR, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANJALI
Authorized Official - Middle Name:
Authorized Official - Last Name:KHERDEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-353-7417
Mailing Address - Street 1:12 CARE CIR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-2118
Mailing Address - Country:US
Mailing Address - Phone:806-353-7417
Mailing Address - Fax:806-353-4007
Practice Address - Street 1:12 CARE CIR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-2118
Practice Address - Country:US
Practice Address - Phone:806-353-7417
Practice Address - Fax:806-353-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y655Medicare PIN