Provider Demographics
NPI:1164452959
Name:GHOSHEH, KHALID Z (MD)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:Z
Last Name:GHOSHEH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2700 STANLEY GAULT PKWY
Mailing Address - Street 2:STE 129
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-253-4917
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:4003 KRESGE WAY
Practice Address - Street 2:SUITE 500
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5603
Practice Address - Country:US
Practice Address - Phone:502-897-1166
Practice Address - Fax:502-897-1461
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-12-03
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Provider Licenses
StateLicense IDTaxonomies
MIKG070022207RH0003X
KY40813207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G31085OtherBLUE CARE NETWORK
MI145830OtherGREAT LAKES HEALTH PLAN
MI383553403051OtherCOMMUNITY CHOICE
MI7293569OtherAETNA
MI1011761OtherMCLAREN HEALTH PLAN
MI4613430Medicaid
KY7100018150Medicaid
KY50027665OtherPASSPORT
KY000000652544OtherANTHEM
MI0G31085OtherBLUE CROSS BLUE SHIELD
KY3770662000OtherPASSPORT ADVANTAGE
MI0998652OtherHEALTH PLUS
MI0G31085OtherBLUE CARE NETWORK
MION31240003Medicare PIN
KY0144604Medicare PIN