Basic Information
| Provider Information | |||||||||
| NPI: | 1841334174 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHALAF | ||||||||
| FirstName: | MAJID | ||||||||
| MiddleName: | RAFIK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1936 32ND AVE | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329602573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7727788882 | ||||||||
| FaxNumber: | 7727788894 | ||||||||
| Practice Location | |||||||||
| Address1: | 1936 32ND AVE | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329602573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7727788882 | ||||||||
| FaxNumber: | 7727788894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2007 | ||||||||
| LastUpdateDate: | 04/11/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | ME87468 | FL | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | U3904A | 01 | MEDICARE PTAN | OTHER |