Provider Demographics
NPI:1942904776
Name:MUKHARA, DEEPIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPIKA
Middle Name:
Last Name:MUKHARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 DEKALB AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5493
Mailing Address - Country:US
Mailing Address - Phone:718-250-6604
Mailing Address - Fax:
Practice Address - Street 1:22151 MOROSS RD STE 214
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2151
Practice Address - Country:US
Practice Address - Phone:313-343-4867
Practice Address - Fax:313-343-3280
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4351050753208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program