MEDICARE: SANDEEP 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	207RG0100X	Gastroenterology Physician	21355	NE

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	:	1760432066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDEEP MUKHERJEE MD

Provider Business Mailing Address
First Line	:	601 N 30TH ST
Second Line	:	STE 5730
City	:	OMAHA
State	:	NE
Zip	:	68131-2128
Country	:	US
Telephone Number	:	402-449-4692
Fax Number	:	402-449-5926

Provider Business Practice Location Address
First Line	:	601 N 30TH ST
Second Line	:	STE 5730
City	:	OMAHA
State	:	NE
Zip	:	68131-2128
Country	:	US
Telephone Number	:	402-449-4692
Fax Number	:	402-449-5926

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	01/16/2015

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Directions to “ SANDEEP MUKHERJEE MD” Practice Location

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