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1265691364

NPI Code Detail

MEDICARE: HIMAD ULLAH KHAN KHATTAK MD

MEDICARE: HIMAD ULLAH KHAN KHATTAK 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	208M00000X	Hospitalist Physician	2008014651	MO
2	207RC0000X	Cardiovascular Disease Physician	35.123560	OH
3	207R00000X	Internal Medicine Physician	2008014651	MO
4	207R00000X	Internal Medicine Physician	35123560	OH

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

General Provider Information

NPI Number	:	1265691364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HIMAD ULLAH KHAN KHATTAK MD

Provider Business Mailing Address
First Line	:	3170 KETTERING BLVD BLDG B3
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1924
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5275 STATE ROUTE 122 STE 200
Second Line	:
City	:	FRANKLIN
State	:	OH
Zip	:	45005-9617
Country	:	US
Telephone Number	:	513-217-6400
Fax Number	:

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

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	01/20/2026

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Directions to “ HIMAD ULLAH KHAN KHATTAK MD” Practice Location

Language	Start Address	Practice Location

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