Healthcare Provider Details

I. General information

NPI: 1033405774
Provider Name (Legal Business Name): NAREESHA KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 S HIGHLAND AVE
CLEARWATER FL
33756-4446
US

IV. Provider business mailing address

7050 ULMERTON RD
LARGO FL
33771-5003
US

V. Phone/Fax

Practice location:
  • Phone: 727-219-1833
  • Fax: 305-698-6536
Mailing address:
  • Phone: 727-777-4540
  • Fax: 305-698-6536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME119066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: