Provider Demographics
NPI:1568632453
Name:NASIR KHALIDI & SAKINA KHALIDI, MD PA
Entity Type:Organization
Organization Name:NASIR KHALIDI & SAKINA KHALIDI, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAKINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:KHALIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-629-3113
Mailing Address - Street 1:PO BOX 496420
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-6420
Mailing Address - Country:US
Mailing Address - Phone:941-629-3113
Mailing Address - Fax:941-629-9764
Practice Address - Street 1:2400 HARBOR BLVD
Practice Address - Street 2:SUITE 17
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5052
Practice Address - Country:US
Practice Address - Phone:941-629-3113
Practice Address - Fax:941-629-9764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32809207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93657AOtherMEDICARE PTAN NUMBER
FLK8954Medicare PIN