Provider Demographics
NPI:1922262153
Name:ALQAHTANI, MASHAEL F (MD)
Entity type:Individual
Prefix:DR
First Name:MASHAEL
Middle Name:F
Last Name:ALQAHTANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10140 CENTURION PARKWAY N.
Mailing Address - Street 2:FL PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0532
Mailing Address - Country:US
Mailing Address - Phone:904-697-4100
Mailing Address - Fax:904-697-5102
Practice Address - Street 1:KY CHILDREN'S HOSPITAL 800 ROSE ST 4TH FL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-7884
Practice Address - Country:US
Practice Address - Phone:859-218-0921
Practice Address - Fax:859-257-1831
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124582208000000X, 2080P0203X
KY593142080P0203X
KYTP1282080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015221400Medicaid