Healthcare Provider Details

I. General information

NPI: 1609038082
Provider Name (Legal Business Name): MUKTI AICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 07/26/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 SW SR 200 UNIT 400
OCALA FL
34481
US

IV. Provider business mailing address

2301 E 14TH ST
DES MOINES IA
50316-1901
US

V. Phone/Fax

Practice location:
  • Phone: 352-861-1667
  • Fax: 352-861-1659
Mailing address:
  • Phone: 515-262-0404
  • Fax: 515-262-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT192576
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39519
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME155541
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: