Provider Demographics
NPI:1821321357
Name:NAGUI N KHOUZAM MD PA
Entity Type:Organization
Organization Name:NAGUI N KHOUZAM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NAGUI/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGUI
Authorized Official - Middle Name:N
Authorized Official - Last Name:KHOUZAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-656-4549
Mailing Address - Street 1:54 E PLANT ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3127
Mailing Address - Country:US
Mailing Address - Phone:407-656-4549
Mailing Address - Fax:407-656-3222
Practice Address - Street 1:54 E PLANT ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3127
Practice Address - Country:US
Practice Address - Phone:407-656-4549
Practice Address - Fax:407-656-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0017130174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054464700Medicaid
FLD55387Medicare UPIN
FL054464700Medicaid