Provider Demographics
NPI:1255342432
Name:KHANNA, UMA (M D)
Entity type:Individual
Prefix:DR
First Name:UMA
Middle Name:
Last Name:KHANNA
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SE 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2801
Mailing Address - Country:US
Mailing Address - Phone:954-523-0106
Mailing Address - Fax:954-525-0540
Practice Address - Street 1:1801 SE 1ST AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2801
Practice Address - Country:US
Practice Address - Phone:954-523-0106
Practice Address - Fax:954-525-0540
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42945207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2414ASOPOtherNEIGBHORHOOD HEALTH PARTN
FL94281OtherBLUECROSS BLUESHIELD
FL200343OtherAMERIGROUP
FL650747893OtherHUMANA HEALTH PLAN
FL171216OtherHEALTHEASE
FL013300OtherAVMED HEALTH PLAN
FL048449100Medicaid
FL0823067OtherAETNA HEALTH INS
FL171216OtherSTAYWELL
FLD63184Medicare UPIN
FL048449100Medicaid