MEDICARE: DR. SUNEEL KHETARPAL M.D.

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	208600000X	Surgery Physician	ME94132	FL
2	2086S0102X	Surgical Critical Care Physician	ME94132	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00242458	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1336114842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUNEEL KHETARPAL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 44008
Second Line	:	UFJP PROVIDER ENROLLMENT
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4008
Country	:	US
Telephone Number	:	904-244-3660
Fax Number	:	904-244-3425

Provider Business Practice Location Address
First Line	:	655 W 8TH ST
Second Line	:	UFJP SURGERY TRAUMA
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6511
Country	:	US
Telephone Number	:	904-244-6631
Fax Number	:	904-244-4687

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

Provider Enumeration Date	:	02/19/2006
Last Update Date	:	09/03/2007

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