Healthcare Provider Details

I. General information

NPI: 1285085654
Provider Name (Legal Business Name): SOHA KHAN RIZVI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOHA A. KHAN DO

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14645 HAZEL DELL RD
NOBLESVILLE IN
46062-7066
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-992-2090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.013840
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11019018A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02005373A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: