Provider Demographics
NPI:1982603965
Name:KHAIRALLAH, FARHAT SELIM (MD)
Entity type:Individual
Prefix:DR
First Name:FARHAT
Middle Name:SELIM
Last Name:KHAIRALLAH
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 1:1300 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4646
Mailing Address - Country:US
Mailing Address - Phone:850-216-0100
Mailing Address - Fax:850-216-0138
Practice Address - Street 1:2100 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4379
Practice Address - Country:US
Practice Address - Phone:850-216-0100
Practice Address - Fax:850-216-0138
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90702207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00000OtherSOUTHCARE
GA00000OtherBEECH ST/CAPP CARE
FL00000OtherUNITED HEALTH CARE
FL00000OtherCAPITAL HEALTH PLAN
FL297944900Medicaid
AL009977225Medicaid
FLSC075814OtherIVSTA
FL00000OtherBCBS OF FL
FL297944900Medicaid
FL00000OtherCAPITAL HEALTH PLAN