Healthcare Provider Details

I. General information

NPI: 1508051277
Provider Name (Legal Business Name): SUMERA TARIQ KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 DOLWICK DR
ERLANGER KY
41018-2774
US

IV. Provider business mailing address

2123 AUBURN AVE STE. 200
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 859-466-0115
  • Fax: 859-287-3297
Mailing address:
  • Phone: 513-585-2414
  • Fax: 513-585-3792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberTP236
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.084372
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35806
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: