Provider Demographics
NPI:1144312521
Name:KHUMALO, BHEKUMUZI MCGLEN (DPM)
Entity type:Individual
Prefix:DR
First Name:BHEKUMUZI
Middle Name:MCGLEN
Last Name:KHUMALO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 BISHOP ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5402
Mailing Address - Country:US
Mailing Address - Phone:731-599-9909
Mailing Address - Fax:731-599-9970
Practice Address - Street 1:1100 BISHOP ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5402
Practice Address - Country:US
Practice Address - Phone:731-599-9909
Practice Address - Fax:731-599-9970
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR177213ES0103X
TN494213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100242870Medicaid
TN3352636Medicaid
KY7100815670Medicaid
TNQ051676Medicaid
TN3380640OtherMEDICARE GROUP
TN3352245Medicare PIN
TN4008710001Medicare NSC
AR5T939Medicare PIN