Healthcare Provider Details

I. General information

NPI: 1255262523
Provider Name (Legal Business Name): DR. FAHIM KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13448 BELLARIA CIR
WINDERMERE FL
34786-7401
US

IV. Provider business mailing address

13448 BELLARIA CIR
WINDERMERE FL
34786-7401
US

V. Phone/Fax

Practice location:
  • Phone: 863-307-8093
  • Fax:
Mailing address:
  • Phone: 863-804-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME179844
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: