MEDICARE: DR. PARVEEN KHANNA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	ME87424	FL
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME87424	FL
3	208VP0014X	Interventional Pain Medicine Physician	ME87424	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	71351	OTHER	FL	BLUECROSSBLUESHIELD
3	618395500	OTHER	FL	WORKERS COMPENSATION
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558346106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PARVEEN KHANNA MD

Provider Business Mailing Address
First Line	:	10250 NORMANDY BLVD
Second Line	:	SUITE 703
City	:	JACKSONVILLE
State	:	FL
Zip	:	32221-8059
Country	:	US
Telephone Number	:	904-495-7200
Fax Number	:	904-495-7199

Provider Business Practice Location Address
First Line	:	10250 NORMANDY BLVD
Second Line	:	SUITE 703
City	:	JACKSONVILLE
State	:	FL
Zip	:	32221-8059
Country	:	US
Telephone Number	:	904-495-7200
Fax Number	:	904-495-7199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	01/25/2017

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Directions to “ DR. PARVEEN KHANNA MD” Practice Location

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