Healthcare Provider Details

I. General information

NPI: 1528004595
Provider Name (Legal Business Name): MOHAMED ABDEL HAKEEM KHALAF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 SAND KEY ESTATES CT
CLEARWATER BEACH FL
33767-2978
US

IV. Provider business mailing address

1640 SAND KEY ESTATES CT
CLEARWATER BEACH FL
33767-2978
US

V. Phone/Fax

Practice location:
  • Phone: 716-622-4374
  • Fax:
Mailing address:
  • Phone: 716-622-4374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME74652
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34115
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME74652
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number34115
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME74652
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34115
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: