Healthcare Provider Details

I. General information

NPI: 1598878456
Provider Name (Legal Business Name): NARENDRA R KHENGAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 02/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CARPATHIAN DR
COLUMBIA MO
65203-0192
US

IV. Provider business mailing address

8200 NO MORE VICTIMS RD J.C.C.C.
JEFFERSON CTY MO
65101-4539
US

V. Phone/Fax

Practice location:
  • Phone: 573-445-4279
  • Fax:
Mailing address:
  • Phone: 573-751-3224
  • Fax: 573-761-0305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD106179
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberMD106179
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: