MEDICARE: SAMEH N KHOUZAM 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	207RC0000X	Cardiovascular Disease Physician	084219	OH
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	084219	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	:	1881696060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMEH N KHOUZAM MD

Provider Business Mailing Address
First Line	:	4160 LITTLE YORK RD STE 20
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-5803
Country	:	US
Telephone Number	:	937-454-9527
Fax Number	:	937-454-9532

Provider Business Practice Location Address
First Line	:	4160 LITTLE YORK RD STE 20
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414
Country	:	US
Telephone Number	:	937-454-9527
Fax Number	:	937-454-9532

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	01/19/2021

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Directions to “ SAMEH N KHOUZAM MD” Practice Location

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