Organization
ST. PETERSBURG MEDICAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMED KHALAF MD (MANAGER)
(716) 438-3546
Entity
Organization
Contact information
Practice address
225 EAST AVE, LOCKPORT, NY 14094-3812
(716) 438-3546
Mailing address
2001 16TH ST N, ATTN:PAUL C JENSEN, ST PETERSBURG, FL 33704-3921
(716) 438-3546
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
202334
NY
207VG0400X
Gynecology Physician
Primary
202334
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01636066
—
NY
Enumeration date
10/10/2016
Last updated
10/10/2016
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