Healthcare Provider Details

I. General information

NPI: 1376705681
Provider Name (Legal Business Name): FARAZ KHURSHEED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 STIRLING RD STE 1
HOLLYWOOD FL
33024-8067
US

IV. Provider business mailing address

10000 STIRLING RD STE 1
HOLLYWOOD FL
33024-8067
US

V. Phone/Fax

Practice location:
  • Phone: 954-748-7474
  • Fax:
Mailing address:
  • Phone: 954-748-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD.207042
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME122905
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME122905
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: