MEDICARE: TALIEH HENDI M.D.

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	207R00000X	Internal Medicine Physician	35.091928	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	:	1861694341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALIEH HENDI M.D.

Provider Business Mailing Address
First Line	:	1425 N FAIRFIELD RD. STE 110
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2645
Country	:	US
Telephone Number	:	937-426-0106
Fax Number	:	937-426-7153

Provider Business Practice Location Address
First Line	:	1425 N FAIRFIELD RD STE 110
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2674
Country	:	US
Telephone Number	:	937-426-0106
Fax Number	:	937-426-7153

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	01/05/2023

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Directions to “ TALIEH HENDI M.D.” Practice Location

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