MEDICARE: DR. VIVEK KHANDELWAL M.D.

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	207R00000X	Internal Medicine Physician	MD427120	PA
2	207R00000X	Internal Medicine Physician	35-094324	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4273911	OTHER	OH	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699734038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVEK KHANDELWAL M.D.

Provider Business Mailing Address
First Line	:	970 E WASHINGTON ST
Second Line	:	SUITE #2F
City	:	MEDINA
State	:	OH
Zip	:	44256-2181
Country	:	US
Telephone Number	:	330-723-7999
Fax Number	:	330-764-9907

Provider Business Practice Location Address
First Line	:	970 E WASHINGTON ST
Second Line	:	SUITE #2F
City	:	MEDINA
State	:	OH
Zip	:	44256-2181
Country	:	US
Telephone Number	:	330-723-7999
Fax Number	:	330-764-9907

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	10/29/2009

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