Provider Demographics
NPI:1932563962
Name:KHAROD, SHIVAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIVAM
Middle Name:
Last Name:KHAROD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 WATERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5258
Mailing Address - Country:US
Mailing Address - Phone:352-253-3600
Mailing Address - Fax:352-253-3647
Practice Address - Street 1:4000 WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5258
Practice Address - Country:US
Practice Address - Phone:352-253-3600
Practice Address - Fax:352-253-3647
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
FLME1488132085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program