MEDICARE: DR. MOUNIR FAWZI KHALIL 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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	25IA12978200	NJ
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	ME175076	FL
3	390200000X	Student in an Organized Health Care Education/Training Program
4	208100000X	Physical Medicine & Rehabilitation Physician	P5827	TX
5	208100000X	Physical Medicine & Rehabilitation Physician	57125	WI

General Provider Information

NPI Number	:	1831322189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOUNIR FAWZI KHALIL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20433 BRUCE B DOWNS BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2759
Country	:	US
Telephone Number	:	813-214-6635
Fax Number	:

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

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	03/23/2026

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