MEDICARE: IBTHAJ UR REHMAN KHILJI

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	207Q00000X	Family Medicine Physician	35.147558	OH
2	207Q00000X	Family Medicine Physician	TP979	KY

General Provider Information

NPI Number	:	1235756743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IBTHAJ UR REHMAN KHILJI

Provider Business Mailing Address
First Line	:	217 HUGHES BLVD
Second Line	:
City	:	MOUNT ORAB
State	:	OH
Zip	:	45154-8356
Country	:	US
Telephone Number	:	937-550-3657
Fax Number	:	937-661-2683

Provider Business Practice Location Address
First Line	:	217 HUGHES BLVD
Second Line	:
City	:	MOUNT ORAB
State	:	OH
Zip	:	45154-8356
Country	:	US
Telephone Number	:	937-550-3657
Fax Number	:	937-661-2683

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

Provider Enumeration Date	:	06/30/2020
Last Update Date	:	06/08/2026

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