Provider Demographics
NPI:1730995028
Name:KESHOOFY, MOHAMMAD (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:KESHOOFY
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 1:16741 SW 278TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33031-2725
Mailing Address - Country:US
Mailing Address - Phone:705-791-8643
Mailing Address - Fax:
Practice Address - Street 1:180 PARSONS ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:ALLISTON
Practice Address - State:ONTARIO
Practice Address - Zip Code:L9R1E8
Practice Address - Country:CA
Practice Address - Phone:705-435-0391
Practice Address - Fax:705-435-2420
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101284527208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery