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General NPI Number Information
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NPI Number | 1407830292
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Entity Type | Individual
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Provider Name | KHAWAJA KIFAYATULLAH MD
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Gender | Male
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Dates
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Enumeration Date | 12/05/2005
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 8355 NORTHCLIFFE BLVD
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City | SPRING HILL
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State | FL
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Zip | 34606-1139
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Country | US
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Telephone | 352-684-2929
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Fax | 352-684-2646
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Provider Business Mailing Address
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Address Line | 8355 NORTHCLIFFE BLVD
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City | SPRING HILL
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State | FL
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Zip | 34606-1139
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Country | US
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Telephone | 352-684-2929
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Fax | 352-684-2646
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME 87059
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License Number State | FL
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