Healthcare Provider Details

I. General information

NPI: 1578206041
Provider Name (Legal Business Name): KHALED HARMOUCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1096
US

IV. Provider business mailing address

145 SW 13TH ST APT 722
MIAMI FL
33130-4397
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1111
  • Fax:
Mailing address:
  • Phone: 346-448-7949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number39027
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: