Provider Demographics
NPI:1528004595
Name:KHALAF, MOHAMED ABDEL HAKEEM (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:ABDEL HAKEEM
Last Name:KHALAF
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 1:1640 SAND KEY ESTATES CT
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33767-2978
Mailing Address - Country:US
Mailing Address - Phone:716-622-4374
Mailing Address - Fax:
Practice Address - Street 1:1640 SAND KEY ESTATES CT
Practice Address - Street 2:
Practice Address - City:CLEARWATER BEACH
Practice Address - State:FL
Practice Address - Zip Code:33767-2978
Practice Address - Country:US
Practice Address - Phone:716-622-4374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74652207Q00000X, 207VG0400X, 208M00000X
AL34115207Q00000X, 207VG0400X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01636066Medicaid
NYF86409Medicare UPIN
NY12020BMedicare ID - Type Unspecified