Provider Demographics
NPI:1538174297
Name:KHAWAJA, FARHAT JAVED (MD)
Entity type:Individual
Prefix:
First Name:FARHAT
Middle Name:JAVED
Last Name:KHAWAJA
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 1:7754 BAY ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3427
Mailing Address - Country:US
Mailing Address - Phone:772-589-3000
Mailing Address - Fax:772-589-3003
Practice Address - Street 1:7754 BAY ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3427
Practice Address - Country:US
Practice Address - Phone:772-589-3000
Practice Address - Fax:772-589-3003
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME025398207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055456100Medicaid
FLD54202Medicare UPIN
FL31077Medicare ID - Type Unspecified