Provider Demographics
NPI:1699975755
Name:KAMAL, MOHAMMAD KHADER (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:KHADER
Last Name:KAMAL
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:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:4945 SW 49TH PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-9673
Practice Address - Country:US
Practice Address - Phone:352-237-9430
Practice Address - Fax:352-237-9698
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46963207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041687800Medicaid
FLA97034Medicare UPIN
FL041687800Medicaid
FL5909250001OtherNSC