Provider Demographics
NPI:1780641894
Name:LISA ALLEN-KHALIL MD PA
Entity Type:Organization
Organization Name:LISA ALLEN-KHALIL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALLEN-KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-592-5000
Mailing Address - Street 1:11373 CORTEZ BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5411
Mailing Address - Country:US
Mailing Address - Phone:352-592-5000
Mailing Address - Fax:352-592-5001
Practice Address - Street 1:11373 CORTEZ BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5414
Practice Address - Country:US
Practice Address - Phone:352-592-5000
Practice Address - Fax:352-592-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty