Healthcare Provider Details

I. General information

NPI: 1497280705
Provider Name (Legal Business Name): KHALIQ H KURJI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 CEI DRIVE
CINCINNATI OH
45242-5664
US

IV. Provider business mailing address

1945 CEI DRIVE
CINCINNATI OH
45242-5664
US

V. Phone/Fax

Practice location:
  • Phone: 513-569-3741
  • Fax: 513-569-3941
Mailing address:
  • Phone: 513-569-3741
  • Fax: 513-569-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35131078
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: