Healthcare Provider Details

I. General information

NPI: 1912947763
Provider Name (Legal Business Name): ANUP K KHATANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 CEI DRIVE
CINCINNATI OH
45242-3311
US

IV. Provider business mailing address

1945 CEI DRIVE
CINCINNATI OH
45242-3311
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-5133
  • Fax: 513-984-4240
Mailing address:
  • Phone: 513-984-5133
  • Fax: 513-936-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35078630
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: