Healthcare Provider Details

I. General information

NPI: 1669554689
Provider Name (Legal Business Name): KHURRAM SHAHZAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR STE 484
OCOEE FL
34761-3436
US

IV. Provider business mailing address

10000 W COLONIAL DR STE 484
OCOEE FL
34761-3436
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-6444
  • Fax: 407-650-1307
Mailing address:
  • Phone: 321-841-6444
  • Fax: 407-650-1307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME 105659
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: