Provider Demographics
NPI:1770581225
Name:KHANNA, RAJAN (MD)
Entity type:Individual
Prefix:DR
First Name:RAJAN
Middle Name:
Last Name:KHANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6953
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71136-6953
Mailing Address - Country:US
Mailing Address - Phone:318-841-7932
Mailing Address - Fax:318-841-7935
Practice Address - Street 1:1666 E BERT KOUNS INDUSTRIAL LOOP STE 230
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5714
Practice Address - Country:US
Practice Address - Phone:318-841-7932
Practice Address - Fax:318-841-7935
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.11987R207R00000X
LAL11987R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1688576Medicaid
LA1688576Medicaid
LA5Y136Medicare PIN