MEDICARE: TAHER KHALIL M D P A

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	207RC0000X	Cardiovascular Disease Physician	ME81508	FL
2	207RI0011X	Interventional Cardiology Physician	ME81508	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3165111	OTHER	FL	CIGNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	78667	OTHER	FL	BLUECROSS OF FLORIDA
4	7902546	OTHER	FL	AETNA

General Provider Information

NPI Number	:	1821012113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAHER KHALIL M D P A

Provider Business Mailing Address
First Line	:	1425 HAND AVE
Second Line	:	SUITE K
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5063
Country	:	US
Telephone Number	:	386-673-5404
Fax Number	:	386-673-5480

Provider Business Practice Location Address
First Line	:	1425 HAND AVE
Second Line	:	SUITE K
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-1135
Country	:	US
Telephone Number	:	386-673-5404
Fax Number	:	386-673-5480

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	10/29/2024

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Directions to “ TAHER KHALIL M D P A” Practice Location

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