Provider Demographics
NPI:1538199781
Name:MUGHAL, SANJAY (MD)
Entity type:Individual
Prefix:
First Name:SANJAY
Middle Name:
Last Name:MUGHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5410 MARYLAND WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5064
Mailing Address - Country:US
Mailing Address - Phone:615-377-5667
Mailing Address - Fax:888-241-1404
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-3850
Practice Address - Fax:904-244-4799
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2004010178207R00000X
NMMD-2019-0845207R00000X
GA87369207R00000X
FLME100334207R00000X
OK31102208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07893OtherBLUE CROSS/BLUE SHIELD OF FLORIDA
GA245260787AMedicaid
KS603723OtherBLUE CROSS BLUE SHIELD
MO22979012OtherBLUE CROSS BLUE SHIELD
KS100099580NMedicaid
MO1008065OtherAETNA
FL2798123-00Medicaid
MO10001775900OtherCOMMUNITY HEALTH PLAN
MO540156809Medicaid
MO540156809Medicaid
FL2798123-00Medicaid
FLAI103ZMedicare PIN
MO10001775900OtherCOMMUNITY HEALTH PLAN