Provider Demographics
NPI:1093918146
Name:FARHAT J KHAWAJA MEDICAL ASSOCIATES , PA
Entity Type:Organization
Organization Name:FARHAT J KHAWAJA MEDICAL ASSOCIATES , PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARHAT
Authorized Official - Middle Name:JAVED
Authorized Official - Last Name:KHAWAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-589-3000
Mailing Address - Street 1:7754 BAY ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3427
Mailing Address - Country:US
Mailing Address - Phone:772-589-3000
Mailing Address - Fax:772-589-3003
Practice Address - Street 1:7754 BAY ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3427
Practice Address - Country:US
Practice Address - Phone:772-589-3000
Practice Address - Fax:772-589-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0255Medicare ID - Type Unspecified