Basic Information
| Provider Information | |||||||||
| NPI: | 1245452606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHALIL | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 S FISKE BLVD | ||||||||
| Address2: | |||||||||
| City: | ROCKLEDGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329554306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3214341401 | ||||||||
| FaxNumber: | 3219517408 | ||||||||
| Practice Location | |||||||||
| Address1: | 1350 HICKORY ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3214341401 | ||||||||
| FaxNumber: | 3214341667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 01/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | ME98528 | FL | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
ID Information
| ID | Type | State | Issuer | Description | 15633301 | 01 | FL | CITRUS HEALTHCARE | OTHER | 8556767 | 01 | FL | CIGNA | OTHER | 409903 | 01 | FL | WELLCARE | OTHER | 308765 | 01 | FL | AVMED | OTHER | 7645894 | 01 | FL | AETNA | OTHER | 15351 | 01 | FL | BCBS OF FLORIDA | OTHER | ME98528 | 01 | FL | LICENSE | OTHER | NPI | 01 | FL | PHYSICAINS UNITED PLAN | OTHER | AF509 | 01 | FL | MEDICARE | OTHER | 15036 | 01 | UNIVERSAL HEALTHCARE | OTHER | 17 03735 | 01 | FL | UHC | OTHER | 326363 | 01 | FL | AMERIGROUP | OTHER |