Basic Information
| Provider Information | |||||||||
| NPI: | 1588066922 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHATRI | ||||||||
| FirstName: | FAISAL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3170 KETTERING BLVD BLDG B3 | ||||||||
| Address2: | |||||||||
| City: | MORAINE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454391924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9379913186 | ||||||||
| FaxNumber: | 9372239811 | ||||||||
| Practice Location | |||||||||
| Address1: | 4859 NIXON PARK DR STE A | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450408106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134925940 | ||||||||
| FaxNumber: | 5134925941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2014 | ||||||||
| LastUpdateDate: | 10/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R3242 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 01077614A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 35.134977 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.