MEDICARE: DR. DIPAK KUMAR MUKHERJEE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	ME0027748	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	406111598	OTHER		RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124057476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIPAK KUMAR MUKHERJEE MD

Provider Business Mailing Address
First Line	:	5880 49TH ST N
Second Line	:	SUITE 203N
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2150
Country	:	US
Telephone Number	:	727-527-6464
Fax Number	:	727-526-6296

Provider Business Practice Location Address
First Line	:	5880 49TH ST N
Second Line	:	SUITE 203N
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2150
Country	:	US
Telephone Number	:	727-527-6464
Fax Number	:	727-526-6296

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	04/28/2010

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