Provider Demographics
NPI:1235265349
Name:KHORSHID, MILENA (MD)
Entity Type:Individual
Prefix:
First Name:MILENA
Middle Name:
Last Name:KHORSHID
Suffix:
Gender:F
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:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:855-253-4836
Practice Address - Street 1:6110 STATE ROAD 70 E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-9712
Practice Address - Country:US
Practice Address - Phone:941-755-4242
Practice Address - Fax:941-755-1906
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME149588207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL336073097OtherIL CONTROLLED SUBSTANCE
IL036111568Medicaid
IL036111568Medicaid
ILBK7435109OtherDEA NUMBER
IL036111568Medicaid