Provider Demographics
NPI:1447223193
Name:MANZUR, KHALID (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALID
Middle Name:
Last Name:MANZUR
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 1:1462 W OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-3905
Mailing Address - Country:US
Mailing Address - Phone:407-888-6990
Mailing Address - Fax:407-888-3310
Practice Address - Street 1:1462 W OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-3905
Practice Address - Country:US
Practice Address - Phone:407-888-6990
Practice Address - Fax:407-888-3310
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL81287207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1487621694OtherGROUP NPI
FL265886100Medicaid
FLAC081OtherGROUP PTAN
FL265886100Medicaid
A61366Medicare UPIN
FL62935ZMedicare PIN