Provider Demographics
NPI:1396988952
Name:DHALIWAL, KHUSHI ACUSHLA (MD)
Entity type:Individual
Prefix:
First Name:KHUSHI
Middle Name:ACUSHLA
Last Name:DHALIWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5113, SR 674,STE 103
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598
Mailing Address - Country:US
Mailing Address - Phone:813-633-2000
Mailing Address - Fax:
Practice Address - Street 1:5113 SR 674, STE 103
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598
Practice Address - Country:US
Practice Address - Phone:813-633-2000
Practice Address - Fax:813-849-9301
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006450100Medicaid
FL006450100Medicaid