MEDICARE: FAIZUDDIN KHAJA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	35.097073	OH
2	207W00000X	Ophthalmology Physician	44434	KY
3	207WX0107X	Retina Specialist (Ophthalmology) Physician	35.097073	OH
4	207WX0107X	Retina Specialist (Ophthalmology) Physician	44434	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043409873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAIZUDDIN KHAJA MD

Provider Business Mailing Address
First Line	:	2865 CHANCELLOR DR
Second Line	:	STE 215
City	:	CRESTVIEW HILLS
State	:	KY
Zip	:	41017-3931
Country	:	US
Telephone Number	:	859-581-7120
Fax Number	:	859-581-7207

Provider Business Practice Location Address
First Line	:	2055 READING RD
Second Line	:	SUITE 330
City	:	CINCINNATI
State	:	OH
Zip	:	45202-1461
Country	:	US
Telephone Number	:	513-381-1900
Fax Number	:	513-287-6403

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	04/04/2017

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Directions to “ FAIZUDDIN KHAJA MD” Practice Location

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