Provider Demographics
NPI:1821534058
Name:DR. ALIM KHANDEKAR PLLC
Entity Type:Organization
Organization Name:DR. ALIM KHANDEKAR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ALIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANDEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-396-3061
Mailing Address - Street 1:1264 WESLEY DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-6400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1264 WESLEY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6400
Practice Address - Country:US
Practice Address - Phone:901-396-3061
Practice Address - Fax:901-207-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10427208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6005703OtherBCBS TN
TN1506167Medicaid
TN6005703OtherBCBS TN