Healthcare Provider Details

I. General information

NPI: 1689096281
Provider Name (Legal Business Name): MANWANT KHATKAR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 W HILLSBORO BLVD SUITE 107
COCONUT CREEK FL
33073-4395
US

IV. Provider business mailing address

5300 W HILLSBORO BLVD SUITE 107
COCONUT CREEK FL
33073-4395
US

V. Phone/Fax

Practice location:
  • Phone: 954-725-4141
  • Fax: 954-725-4318
Mailing address:
  • Phone: 954-725-4141
  • Fax: 954-725-4318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9106746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: