Provider Demographics
NPI:1144203399
Name:KHOUZAM, NAGUI N (MD)
Entity Type:Individual
Prefix:DR
First Name:NAGUI
Middle Name:N
Last Name:KHOUZAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 E PLANT ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3127
Mailing Address - Country:US
Mailing Address - Phone:407-656-4549
Mailing Address - Fax:407-656-3222
Practice Address - Street 1:54 E PLANT ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3127
Practice Address - Country:US
Practice Address - Phone:407-656-4549
Practice Address - Fax:407-656-3222
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0017130207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55387Medicare UPIN
FL48670Medicare ID - Type Unspecified