MEDICARE: AHMAD G KSAIBATI 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	207P00000X	Emergency Medicine Physician	ME44509	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	:	1609824259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHMAD G KSAIBATI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 48
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33509-0048
Country	:	US
Telephone Number	:	813-685-4205
Fax Number	:

Provider Business Practice Location Address
First Line	:	5504 GATEWAY BLVD
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-4270
Country	:	US
Telephone Number	:	813-948-5400
Fax Number	:	813-907-2073

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	01/27/2010

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