Provider Demographics
NPI:1558363960
Name:KHODADAD, RHAZES KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:RHAZES
Middle Name:KEVIN
Last Name:KHODADAD
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 637676
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:513-451-6871
Mailing Address - Fax:513-451-6876
Practice Address - Street 1:425 FARRELL CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45233-1677
Practice Address - Country:US
Practice Address - Phone:513-451-6871
Practice Address - Fax:513-451-6876
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080129K207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2338554Medicaid
OHH67802Medicare UPIN
OH2338554Medicaid