Healthcare Provider Details

I. General information

NPI: 1265847883
Provider Name (Legal Business Name): GURPREET KHAKH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DRIVE
COLUMBIA MO
65202
US

IV. Provider business mailing address

1 HOSPITAL DRIVE
COLUMBIA MO
65202
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-1515
  • Fax: 573-884-0070
Mailing address:
  • Phone: 573-882-1515
  • Fax: 573-884-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2014019451
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: