Healthcare Provider Details

I. General information

NPI: 1609824259
Provider Name (Legal Business Name): AHMAD G KSAIBATI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5504 GATEWAY BLVD
WESLEY CHAPEL FL
33543-4270
US

IV. Provider business mailing address

PO BOX 48
BRANDON FL
33509-0048
US

V. Phone/Fax

Practice location:
  • Phone: 813-948-5400
  • Fax: 813-907-2073
Mailing address:
  • Phone: 813-685-4205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME44509
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: