Provider Demographics
NPI:1942281761
Name:KHETPAL, VIKRAM (MD)
Entity Type:Individual
Prefix:
First Name:VIKRAM
Middle Name:
Last Name:KHETPAL
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 1:3970 DEPUTY BILL CANTRELL MEMORIAL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040
Mailing Address - Country:US
Mailing Address - Phone:678-513-2273
Mailing Address - Fax:678-513-8869
Practice Address - Street 1:3970 DEPUTY BILL CANTRELL MEMORIAL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:678-513-2273
Practice Address - Fax:678-513-8869
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL21287174400000X
GA57757207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA499957792AMedicaid
AL000034969Medicaid
MS00119609Medicaid
MS00119609Medicaid
AL000034969Medicaid
G58752Medicare UPIN