MEDICARE: DR. SHIVAM KHAROD 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	390200000X	Student in an Organized Health Care Education/Training Program		FL
2	2085R0001X	Radiation Oncology Physician	ME148813	FL

General Provider Information

NPI Number	:	1932563962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIVAM KHAROD M.D.

Provider Business Mailing Address
First Line	:	4000 WATERMAN WAY
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-5258
Country	:	US
Telephone Number	:	352-253-3600
Fax Number	:	352-253-3647

Provider Business Practice Location Address
First Line	:	4000 WATERMAN WAY
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-5258
Country	:	US
Telephone Number	:	352-253-3600
Fax Number	:	352-253-3647

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

Provider Enumeration Date	:	04/06/2016
Last Update Date	:	12/20/2022

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