Basic Information
| Provider Information | |||||||||
| NPI: | 1578801056 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHALIL | ||||||||
| FirstName: | ELIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5900 LAKE ELLENOR DR STE 700 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328094643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073522542 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5900 LAKE ELLENOR DR STE 700 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328094643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073522542 | ||||||||
| FaxNumber: | 4079653785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2013 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME1510605 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 27584 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 208M00000X | ME151605 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist | 282N00000X | ME151605 | FL | Y | Hospitals | General Acute Care Hospital |
No ID Information.