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General NPI Number Information
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NPI Number | 1699344663
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Entity Type | Organization
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Legal Business Name | CHANNAN MD PA
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 660 GLADES RD STE 140
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City | BOCA RATON
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State | FL
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Zip | 33431-6466
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Country | US
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Telephone | 561-447-7737
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Fax | 561-447-9022
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Provider Business Mailing Address
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Address Line | 660 GLADES RD STE 140
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City | BOCA RATON
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State | FL
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Zip | 33431-6466
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Country | US
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Telephone | 561-447-7737
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Fax | 561-447-9022
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | GITANJLI CHANNAN
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Credential | MD
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Telephone | 513-316-7639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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