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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