Provider Demographics
NPI:1144760059
Name:KHLAED DIAB MD, PA
Entity Type:Organization
Organization Name:KHLAED DIAB MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDE/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-947-1788
Mailing Address - Street 1:828 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-4438
Mailing Address - Country:US
Mailing Address - Phone:954-947-1788
Mailing Address - Fax:
Practice Address - Street 1:828 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-4438
Practice Address - Country:US
Practice Address - Phone:954-947-1788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty