Provider Demographics
NPI:1336187442
Name:KHANNA, ANISH K (MD)
Entity Type:Individual
Prefix:
First Name:ANISH
Middle Name:K
Last Name:KHANNA
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 1:910 SW 1ST AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0904
Mailing Address - Country:US
Mailing Address - Phone:352-304-5990
Mailing Address - Fax:352-304-5993
Practice Address - Street 1:910 SW 1ST AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0904
Practice Address - Country:US
Practice Address - Phone:352-304-5990
Practice Address - Fax:352-304-5993
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225438207R00000X
FLME99354207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00617598OtherMEDICARE RAILROAD
FL002616900Medicaid
FL99267OtherBCBS
NY02353120Medicaid
FL29301OtherBCBS
FL99267OtherBCBS
FL002616900Medicaid
FLP00617598OtherMEDICARE RAILROAD
NY02353120Medicaid
FL092A21Medicare PIN