Basic Information
| Provider Information | |||||||||
| NPI: | 1528563814 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHADR | ||||||||
| FirstName: | ARIEL | ||||||||
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| Credential: | HAS #AW5349 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7600 SW 57TH AVE STE 125 | ||||||||
| Address2: | |||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331435421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056617672 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7600 SW 57TH AVE STE 125 | ||||||||
| Address2: | |||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331435421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056617672 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2018 | ||||||||
| LastUpdateDate: | 03/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 5349 | FL | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | 5349 | 01 | FL | HAS | OTHER |