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General NPI Number Information
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NPI Number | 1457434169
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Entity Type | Organization
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Legal Business Name | TAREQ AL-KHATIB
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 09/25/2007
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Provider Practice Location Address
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Address Line | 2852 TAMIAMI TR STE 5
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952
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Country | US
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Telephone | 941-625-4442
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Fax | 941-625-9797
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Provider Business Mailing Address
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Address Line | 2852 TAMIAMI TR STE 5
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952
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Country | US
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Telephone | 941-625-4442
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Fax | 941-625-9797
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Authorized Official
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Title or Position | MD
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Name | MR. TAREQ AL-KHATIB
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Credential | MD
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Telephone | 941-625-4442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME0054121
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License Number State | FL
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