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NPI Code Detail

MEDICARE: RAVDEEP S KHANUJA M.D.

MEDICARE: RAVDEEP S KHANUJA 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
12084P0800XPsychiatry Physician118304MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750433256
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAVDEEP S KHANUJA M.D.
Provider Business Mailing Address
First Line : 3001 WARRIOR LN
Second Line : P.O. BOX 280
City : POPLAR BLUFF
State : MO
Zip : 63901-8685
Country : US
Telephone Number : 573-686-1200
Fax Number : 573-686-1029
Provider Business Practice Location Address
First Line : 3001 WARRIOR LN
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63901-8685
Country : US
Telephone Number : 573-686-1200
Fax Number : 573-686-1029
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2007
Last Update Date : 03/17/2022

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