Healthcare Provider Details

I. General information

NPI: 1346577558
Provider Name (Legal Business Name): DURKHANI MAHBOOB M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W ALEXANDER ST
PLANT CITY FL
33563-7116
US

IV. Provider business mailing address

1324 LAKELAND HILLS BLVD. ATTN: MANAGED CARE DEPT.
LAKELAND FL
33805
US

V. Phone/Fax

Practice location:
  • Phone: 863-284-5115
  • Fax: 863-284-1916
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2012019222
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2012019222
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME132675
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: