Provider Demographics
NPI:1023660198
Name:KHALIFA, MAHMOUD S (MD)
Entity type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:S
Last Name:KHALIFA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2471 GRAND AVE APT 6B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-5178
Mailing Address - Country:US
Mailing Address - Phone:347-986-5003
Mailing Address - Fax:
Practice Address - Street 1:301 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5167
Practice Address - Country:US
Practice Address - Phone:386-231-1091
Practice Address - Fax:386-231-1092
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME155253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine