MEDICARE: YEHIA A. KHOGA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	036090712	IL
2	2084P0804X	Child & Adolescent Psychiatry Physician	63732-20	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063400810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEHIA A. KHOGA MD

Provider Business Mailing Address
First Line	:	1969 W HART RD
Second Line	:
City	:	BELOIT
State	:	WI
Zip	:	53511-2230
Country	:	US
Telephone Number	:	608-364-5686
Fax Number	:	608-363-5756

Provider Business Practice Location Address
First Line	:	1969 W HART RD
Second Line	:
City	:	BELOIT
State	:	WI
Zip	:	53511-2230
Country	:	US
Telephone Number	:	608-364-5686
Fax Number	:	608-363-5756

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	03/21/2018

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