Provider Demographics
NPI:1285686428
Name:YAQOOB, KHALID (MD)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:
Last Name:YAQOOB
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 1:450 W STATE ROAD 434
Mailing Address - Street 2:STE 301
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5187
Mailing Address - Country:US
Mailing Address - Phone:407-767-8200
Mailing Address - Fax:407-339-1200
Practice Address - Street 1:450 W STATE ROAD 434
Practice Address - Street 2:STE 301
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5187
Practice Address - Country:US
Practice Address - Phone:407-767-8200
Practice Address - Fax:407-339-1200
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91454207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG17578Medicare UPIN