Provider Demographics
NPI:1154334936
Name:MUKERJEE, PRASHANT K (MD)
Entity type:Individual
Prefix:DR
First Name:PRASHANT
Middle Name:K
Last Name:MUKERJEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:27890 CLINTON KEITH RD STE 2
Mailing Address - Street 2:MAIL BOX 380
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8571
Mailing Address - Country:US
Mailing Address - Phone:951-973-8130
Mailing Address - Fax:951-808-0957
Practice Address - Street 1:35673 COUNTRY PARK DR
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7840
Practice Address - Country:US
Practice Address - Phone:951-973-8130
Practice Address - Fax:951-808-0957
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2017-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC54408207RP1001X
PAMD016833E207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0061650000OtherINDEPENDENCE BLUE CROSS
PAE55499OtherSENIORPARTNERS HEALTHPART
PA0059907407OtherAMERICHOICE M/C & M.A.
PA159440OtherHIGHMARK BLUE SHIELD
PA31903AOtherKEYSTONE MERCY HEALTH PLN
PADES140OtherOXFORD
PA0005990740002Medicaid
PA2Y5985OtherELDERHEALTH
PA159440OtherAETNA U.S. HEALTHCARE
PA159440OtherCIGNA INSURANCE COMPANY
PAE55499Medicare UPIN
PA0005990740002Medicaid
PA159440OtherAETNA U.S. HEALTHCARE