Provider Demographics
NPI:1225019888
Name:KHOUZAM, JUVY M (MD)
Entity Type:Individual
Prefix:
First Name:JUVY
Middle Name:M
Last Name:KHOUZAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632317
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2317
Mailing Address - Country:US
Mailing Address - Phone:937-208-6173
Mailing Address - Fax:937-208-3843
Practice Address - Street 1:1 WYOMING STREET
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-6173
Practice Address - Fax:937-208-3843
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084318207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2530585Medicaid