Healthcare Provider Details

I. General information

NPI: 1184547317
Provider Name (Legal Business Name): FATIMAH KHATTAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 REID PKWY
RICHMOND IN
47374-1157
US

IV. Provider business mailing address

1817 CHESTER BLVD
RICHMOND IN
47374-1677
US

V. Phone/Fax

Practice location:
  • Phone: 765-935-8808
  • Fax: 765-935-8437
Mailing address:
  • Phone: 765-407-2194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: