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Organization
KHASHABA LLC
Active
Organization
KHASHABA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMAR A KASHABA MD (OWNER)
(201) 888-8250
Entity
Organization
Contact information
Practice address
250 N WICKHAM RD, MELBOURNE, FL 32935-8625
(321) 752-1517
Mailing address
250 N WICKHAM RD, MELBOURNE, FL 32935-8625
(321) 752-1571
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004665600
—
FL
05
—
024500900
—
FL
01
—
DY1649
RRMEDICARE PTAN
FL
01
—
FY303T
MEDICARE - FL
FL
01
—
JH488A
MEDICARE PTAN
FL
Enumeration date
01/30/2018
Last updated
11/17/2020
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