Provider Demographics
NPI:1497762041
Name:KHAMISANI, SALEEM R (MD)
Entity Type:Individual
Prefix:DR
First Name:SALEEM
Middle Name:R
Last Name:KHAMISANI
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 1:1201 5TH AVE N STE 202
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1410
Mailing Address - Country:US
Mailing Address - Phone:727-820-7701
Mailing Address - Fax:727-820-7700
Practice Address - Street 1:1201 5TH AVENUE
Practice Address - Street 2:STE 202
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1410
Practice Address - Country:US
Practice Address - Phone:727-820-7701
Practice Address - Fax:727-820-7700
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME835022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00759244OtherRAILROAD MEDICARE PROVIDER NUMBER
FL273445100Medicaid
FLP00759244OtherRAILROAD MEDICARE PROVIDER NUMBER
FL82624YMedicare PIN