Provider Demographics
NPI:1285637298
Name:KHAIRA, DIVIS K (MD)
Entity type:Individual
Prefix:
First Name:DIVIS
Middle Name:K
Last Name:KHAIRA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 420
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5491
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8931 COLONIAL CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7809
Practice Address - Country:US
Practice Address - Phone:239-343-9567
Practice Address - Fax:239-343-9571
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2648207RH0003X
WAMD60789499207RH0003X
FLME172684208M00000X
NC2014-00861207R00000X, 207RH0003X
NY319482207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100098395Medicaid
FL126187300Medicaid
WYW24590Medicare PIN
AZ418138Medicaid