1679582803 NPI number — DR. NITIN KHANNA MD

Table of content: DR. NITIN KHANNA MD (NPI 1679582803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679582803 NPI number — DR. NITIN KHANNA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHANNA
Provider First Name:
NITIN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679582803
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3329
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNSTER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46321-3329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-924-3300
Provider Business Mailing Address Fax Number:
219-934-2658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 45TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNSTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46321-2818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-924-3300
Provider Business Practice Location Address Fax Number:
219-934-2658
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  01057387A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0117X , with the licence number: 01057387A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000104771 . This is a "ANTHEM GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 61560247 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CI3318 . This is a "RRMEDICARE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7873468 . This is a "AETNA DR KHANNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001051714 . This is a "BCIL KHANNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 129555400 . This is a "US DEPT LABOR GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200135850A . This is a "MEDICAID IN GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 901926 . This is a "UNITED HLTHCARE DR KHANNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 140220 . This is a "MEDICARE GROUP SMMN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9000692 . This is a "BCIL GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000293387 . This is a "ANTHEM KHANNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 2080835 . This is a "FIRST HEALTH DR KHANNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 874640 . This is a "MEDICARE GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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