MEDICARE: DR. REZA KHATIB M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	098762	NY

General Provider Information

NPI Number	:	1679839674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REZA KHATIB M.D.

Provider Business Mailing Address
First Line	:	4661 - SW THISTLE TERRACE
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4661 - SW THISTLE TERRACE
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990
Country	:	US
Telephone Number	:	772-287-9117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	04/04/2012

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