Provider Demographics
NPI:1245452606
Name:KHALIL, STEVEN A (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:KHALIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6063
Mailing Address - Fax:904-539-4091
Practice Address - Street 1:999 N CURTIS RD STE 415
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1334
Practice Address - Country:US
Practice Address - Phone:208-302-2600
Practice Address - Fax:208-302-2625
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME985282086S0102X
IDM-176922086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
15036OtherUNIVERSAL HEALTHCARE
FL15633301OtherCITRUS HEALTHCARE
FL308765OtherAVMED
FL326363OtherAMERIGROUP
FL409903OtherWELLCARE
FL7645894OtherAETNA
FLNPIOtherPHYSICAINS UNITED PLAN
FL17 03735OtherUHC
FL15351OtherBCBS OF FLORIDA
FL8556767OtherCIGNA
FLAF509OtherMEDICARE
FLME98528OtherLICENSE
FL326363OtherAMERIGROUP