Provider Demographics
NPI:1396784393
Name:NAYER N. KHOUZAM, M.D., P.A.
Entity type:Organization
Organization Name:NAYER N. KHOUZAM, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAYER
Authorized Official - Middle Name:N
Authorized Official - Last Name:KHOUZAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-650-0000
Mailing Address - Street 1:3802 OAKWATER CIR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6200
Mailing Address - Country:US
Mailing Address - Phone:407-650-0000
Mailing Address - Fax:407-650-8757
Practice Address - Street 1:3802 OAKWATER CIR
Practice Address - Street 2:SUITE 3
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6200
Practice Address - Country:US
Practice Address - Phone:407-650-0000
Practice Address - Fax:407-650-8757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL48829208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48829OtherME NUMBER
FL375411100Medicaid
FL48829OtherME NUMBER
FLK1128Medicare ID - Type Unspecified