Basic Information
| Provider Information | |||||||||
| NPI: | 1336304294 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | RAFIULLAH | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | RAFIULLAH | ||||||||
| OtherFirstName: | FNU | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4460 RED BANK RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452272172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133214333 | ||||||||
| FaxNumber: | 5135336033 | ||||||||
| Practice Location | |||||||||
| Address1: | 4460 RED BANK RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452272172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133214333 | ||||||||
| FaxNumber: | 5135336033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2008 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD-43461 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 55530 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 01085536A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 35.133202 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.