Provider Demographics
NPI:1770618837
Name:GOEL, MUKESH (MD)
Entity type:Individual
Prefix:DR
First Name:MUKESH
Middle Name:
Last Name:GOEL
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 1:6710 OLD WOLF BAY ROAD
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177
Mailing Address - Country:US
Mailing Address - Phone:386-326-1590
Mailing Address - Fax:386-326-1592
Practice Address - Street 1:6710 OLD WOLF BAY RD
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177
Practice Address - Country:US
Practice Address - Phone:386-326-1590
Practice Address - Fax:386-326-1592
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77178207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255446100Medicaid
FLE1684ZMedicare PIN
FLF23749Medicare UPIN