MEDICARE: DR. SALEEM R. KHAMISANI M.D.

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	2084N0400X	Neurology Physician	ME83502	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00759244	OTHER	FL	RAILROAD MEDICARE PROVIDER NUMBER

Other Identifiers

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

General Provider Information

NPI Number	:	1497762041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALEEM R. KHAMISANI M.D.

Provider Business Mailing Address
First Line	:	1201 5TH AVE N STE 202
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-1410
Country	:	US
Telephone Number	:	727-820-7701
Fax Number	:	727-820-7700

Provider Business Practice Location Address
First Line	:	1201 5TH AVENUE
Second Line	:	STE 202
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33705-1410
Country	:	US
Telephone Number	:	727-820-7701
Fax Number	:	727-820-7700

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	04/04/2022

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Directions to “ DR. SALEEM R. KHAMISANI M.D.” Practice Location

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