Provider Demographics
NPI:1215124128
Name:SANJAY MUKERJI MD PC
Entity type:Organization
Organization Name:SANJAY MUKERJI MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKERJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-725-5030
Mailing Address - Street 1:201 S LLOYD ST
Mailing Address - Street 2:SUITE W230
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4552
Mailing Address - Country:US
Mailing Address - Phone:605-725-5030
Mailing Address - Fax:605-725-5028
Practice Address - Street 1:201 S LLOYD ST
Practice Address - Street 2:SUITE W230
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4552
Practice Address - Country:US
Practice Address - Phone:605-725-5030
Practice Address - Fax:605-725-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD48732086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS8066Medicare PIN
SDG16337Medicare UPIN