Healthcare Provider Details

I. General information

NPI: 1295019727
Provider Name (Legal Business Name): ZIA R KHAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 GLEN EDEN CT
AURORA OH
44202-8436
US

IV. Provider business mailing address

640 GLEN EDEN CT
AURORA OH
44202-8436
US

V. Phone/Fax

Practice location:
  • Phone: 330-562-9650
  • Fax: 330-995-2650
Mailing address:
  • Phone: 330-562-9650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number35.043370
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: