Healthcare Provider Details

I. General information

NPI: 1700229747
Provider Name (Legal Business Name): TARIQ A KHEMEES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 01/25/2022
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 THOMAS LN STE 3G
COLUMBUS OH
43214-1419
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-788-2870
  • Fax: 614-533-0177
Mailing address:
  • Phone: 614-544-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35.139741
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: