Provider Demographics
NPI:1255326328
Name:AFSH, KHALIL M (MD)
Entity type:Individual
Prefix:
First Name:KHALIL
Middle Name:M
Last Name:AFSH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 VILLAGE SQUARE XING STE 290
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4552
Mailing Address - Country:US
Mailing Address - Phone:239-313-2517
Mailing Address - Fax:239-313-2555
Practice Address - Street 1:301 NE 19TH DR
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1911
Practice Address - Country:US
Practice Address - Phone:863-467-6767
Practice Address - Fax:863-467-1919
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068678207R00000X
TXT1890207R00000X
FLME686782086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015004400Medicaid
FL28175VMedicare PIN