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NPI Code Detail

MEDICARE: KHYATI VIJAY KADIA M.D.

MEDICARE: KHYATI VIJAY KADIA M.D.
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
1207Q00000XFamily Medicine Physician125068787IL

General Provider Information

NPI Number : 1639522576
Entity Type Code : Individual
Provider Name (Legal Business Name) : KHYATI VIJAY KADIA M.D.
Provider Business Mailing Address
First Line : 102 S HENNEPIN AVE
Second Line :
City : DIXON
State : IL
Zip : 61021-3013
Country : US
Telephone Number : 815-285-8908
Fax Number : 815-285-8926
Provider Business Practice Location Address
First Line : 102 S HENNEPIN AVE
Second Line :
City : DIXON
State : IL
Zip : 61021-3013
Country : US
Telephone Number : 815-285-8908
Fax Number : 815-285-8926
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2016
Last Update Date : 07/15/2016

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Directions to “ KHYATI VIJAY KADIA M.D.” Practice Location

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