Provider Demographics
NPI:1902911068
Name:SABHA, KHALID (MD)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:
Last Name:SABHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3944 W RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8731
Mailing Address - Country:US
Mailing Address - Phone:239-210-4247
Mailing Address - Fax:
Practice Address - Street 1:3944 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8731
Practice Address - Country:US
Practice Address - Phone:239-210-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT4586208M00000X, 207Q00000X
FLME96707208M00000X, 207Q00000X
CODR.0062496208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL91401OtherBCBS - FL
FLP00466200OtherRR MEDICARE
FL276862300Medicaid
FL276862300Medicaid