Healthcare Provider Details

I. General information

NPI: 1609078385
Provider Name (Legal Business Name): INDRANI MUKHERJEE MBCHB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 NORTH LEE STREET SUITE 203
JACKSONVILLE FL
32204-1128
US

IV. Provider business mailing address

4205 BELFORT ROAD SUITE 4020
JACKSONVILLE FL
32216-1475
US

V. Phone/Fax

Practice location:
  • Phone: 904-354-8200
  • Fax: 904-354-1340
Mailing address:
  • Phone: 904-450-6444
  • Fax: 904-296-9542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number50082
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: