MEDICARE: DR. KHALED DEEB MD, PHD, MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	141889	FL
2	208M00000X	Hospitalist Physician	ME141889	FL
3	207R00000X	Internal Medicine Physician	ME141889	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073044186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHALED DEEB MD, PHD, MBA

Provider Business Mailing Address
First Line	:	6813 FINAMORE CIR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-8727
Country	:	US
Telephone Number	:	954-483-3381
Fax Number	:	954-516-0720

Provider Business Practice Location Address
First Line	:	1010 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-1608
Country	:	US
Telephone Number	:	954-483-3381
Fax Number	:	954-516-0720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2017
Last Update Date	:	04/02/2023

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