Healthcare Provider Details

I. General information

NPI: 1427126820
Provider Name (Legal Business Name): GHAZANFAR KHADIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6833 MEDICAL VIEW LN
ZEPHYRHILLS FL
33542-6614
US

IV. Provider business mailing address

PO BOX 2239
ZEPHYRHILLS FL
33539-2239
US

V. Phone/Fax

Practice location:
  • Phone: 813-780-6687
  • Fax: 813-788-6554
Mailing address:
  • Phone: 813-780-6687
  • Fax: 813-788-6554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME102055
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME102055
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME102055
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: