MEDICARE: MANOJ P KHANDHERIA 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	208800000X	Urology Physician	G4324	TX

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

General Provider Information

NPI Number	:	1861506669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANOJ P KHANDHERIA MD

Provider Business Mailing Address
First Line	:	PO BOX 64056
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79464-4056
Country	:	US
Telephone Number	:	806-795-2533
Fax Number	:	806-795-0336

Provider Business Practice Location Address
First Line	:	2424 50TH ST RM 301
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79412-2561
Country	:	US
Telephone Number	:	806-795-2533
Fax Number	:	806-795-0336

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2010

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Directions to “ MANOJ P KHANDHERIA MD” Practice Location

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