Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | ME119805 | FL |
NPI | 1053562678 |
---|---|
Provider Name | Dr. Faseeh Uddin Khaja |
First Address | St Petersburg, FL 33709-2236 |
Second Address | Largo, FL 33770-2277 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2008 |
Last Update Date | 12/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012596900 | (05) | FL |
14XM2 | BCBS FL (01) | FL |
KX129 | MEDICARE (01) | FL |
KX131 | MEDICARE (01) | FL |