Provider Demographics
NPI:1629148382
Name:KHORASSANI, HASHEM M (MD)
Entity Type:Individual
Prefix:
First Name:HASHEM
Middle Name:M
Last Name:KHORASSANI
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 1:1500 N DIXIE HWY
Mailing Address - Street 2:STE 205 PALM BEACH MED-CARE
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401
Mailing Address - Country:US
Mailing Address - Phone:561-835-8787
Mailing Address - Fax:561-835-8487
Practice Address - Street 1:1500 N DIXIE HWY
Practice Address - Street 2:STE 205 PALM BEACH MED-CARE
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:561-835-8787
Practice Address - Fax:561-835-8487
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0069216207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G22295Medicare UPIN
28314Medicare ID - Type Unspecified