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Organization
ABDUL KHALIL WALLIZADA,MD
Active
Organization
ABDUL KHALIL WALLIZADA,MD
Active
Other names
Pediatrics And Adolescent Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ABDUL KHALIL WALLIZADA MD (OWNER)
(904) 276-0005
Entity
Organization
Contact information
Practice address
2140 KINGSLEY AVE, STE.#10, ORANGE PARK, FL 32073-5180
(904) 276-0005
(904) 276-9202
Mailing address
2140 KINGSLEY AVE, STE.#10, ORANGE PARK, FL 32073-5180
(904) 276-0005
(904) 276-9202
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
ME0067026
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376381100
—
FL
Enumeration date
05/09/2006
Last updated
07/07/2008
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