Provider Demographics
NPI:1407205792
Name:SYED, KHASIM (DO)
Entity Type:Individual
Prefix:
First Name:KHASIM
Middle Name:
Last Name:SYED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:KHASIMUDDIN
Other - Middle Name:
Other - Last Name:SYED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2001 W 68TH ST
Mailing Address - Street 2:ATTN: MEDICAL EDUCATION
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1801
Mailing Address - Country:US
Mailing Address - Phone:713-732-7059
Mailing Address - Fax:
Practice Address - Street 1:3900 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4331
Practice Address - Country:US
Practice Address - Phone:904-222-6656
Practice Address - Fax:904-222-6657
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15706207R00000X, 207RC0000X
FLUO5006390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program