Provider Demographics
NPI:1376705681
Name:KHURSHEED, FARAZ (MD)
Entity Type:Individual
Prefix:
First Name:FARAZ
Middle Name:
Last Name:KHURSHEED
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 1:1164 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-2707
Mailing Address - Country:US
Mailing Address - Phone:954-678-1074
Mailing Address - Fax:
Practice Address - Street 1:1164 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-2707
Practice Address - Country:US
Practice Address - Phone:954-678-1074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2070422084N0400X
FLME122905208VP0014X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2150707Medicaid
MS01872853Medicaid
MS01872853Medicaid
LA2150707Medicaid