Healthcare Provider Details

I. General information

NPI: 1235756743
Provider Name (Legal Business Name): IBTHAJ UR REHMAN KHILJI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 LITTON LN
HEBRON KY
41048-8611
US

IV. Provider business mailing address

217 HUGHES BLVD
MOUNT ORAB OH
45154-8356
US

V. Phone/Fax

Practice location:
  • Phone: 859-334-8700
  • Fax: 859-334-8707
Mailing address:
  • Phone: 937-550-3657
  • Fax: 937-661-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.147558
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number62048
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: