Provider Demographics
NPI:1710980974
Name:MOIN, KHURRAM (MD)
Entity Type:Individual
Prefix:
First Name:KHURRAM
Middle Name:
Last Name:MOIN
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 1:311 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4421
Mailing Address - Country:US
Mailing Address - Phone:407-933-1423
Mailing Address - Fax:407-933-7901
Practice Address - Street 1:311 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4421
Practice Address - Country:US
Practice Address - Phone:407-933-1423
Practice Address - Fax:407-933-7901
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77258207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00089841OtherRAILROAD MEDICARE
FL81272OtherBCBS OF FLORIDA
FLG37096Medicare UPIN
FL81272OtherBCBS OF FLORIDA
FL97822AMedicare PIN
FL97822Medicare PIN