Basic Information
| Provider Information | |||||||||
| NPI: | 1912947763 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHATANA | ||||||||
| FirstName: | ANUP | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1945 CEI DRIVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452423311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139845133 | ||||||||
| FaxNumber: | 5139361090 | ||||||||
| Practice Location | |||||||||
| Address1: | 1945 CEI DRIVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452423311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139845133 | ||||||||
| FaxNumber: | 5139844240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 04/09/2013 | ||||||||
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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 | 207W00000X | 35078630 | OH | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 200304150 | 05 | IN | MEDICAID | 2195888 | 05 | OH | MEDICAID | 180040580 | 01 | OH | RAILROAD MEDICARE | OTHER | 3810002904 | 05 | WV | MEDICAID | 64019706 | 05 | KY | MEDICAID | 000000194855 | 01 | BCBS | OTHER | 4046599 | 05 | TN | MEDICAID |