Provider Demographics
NPI:1518394840
Name:KHELLA, HANI J (MD)
Entity Type:Individual
Prefix:DR
First Name:HANI
Middle Name:J
Last Name:KHELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7122 HAWKS HARBOR CIR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-5862
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1451 TALLEVAST RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-5036
Practice Address - Country:US
Practice Address - Phone:941-753-9199
Practice Address - Fax:941-753-9975
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07184900207Q00000X
FLME122429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine