1568632453 NPI number — NASIR KHALIDI & SAKINA KHALIDI, MD PA

Table of content: (NPI 1568632453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568632453 NPI number — NASIR KHALIDI & SAKINA KHALIDI, MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NASIR KHALIDI & SAKINA KHALIDI, MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568632453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 496420
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT CHARLOTTE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33949-6420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-629-3113
Provider Business Mailing Address Fax Number:
941-629-9764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 HARBOR BLVD
Provider Second Line Business Practice Location Address:
SUITE 17
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33952-5052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-629-3113
Provider Business Practice Location Address Fax Number:
941-629-9764
Provider Enumeration Date:
03/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KHALIDI
Authorized Official First Name:
SAKINA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
941-629-3113

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  ME32809 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 93657A . This is a "MEDICARE PTAN NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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