MEDICARE: INDRANI MUKHERJEE MBCHB

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	207RP1001X	Pulmonary Disease Physician	50082	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00405215	OTHER	MN	MEDICARE RAILROAD

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609078385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDRANI MUKHERJEE MBCHB

Provider Business Mailing Address
First Line	:	4205 BELFORT ROAD
Second Line	:	SUITE 4020
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1475
Country	:	US
Telephone Number	:	904-450-6444
Fax Number	:	904-296-9542

Provider Business Practice Location Address
First Line	:	425 NORTH LEE STREET
Second Line	:	SUITE 203
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-1128
Country	:	US
Telephone Number	:	904-354-8200
Fax Number	:	904-354-1340

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

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	11/25/2014

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Directions to “ INDRANI MUKHERJEE MBCHB” Practice Location

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