Provider Demographics
NPI:1578639282
Name:KHANZADA, ZAKIR JALAL (MD)
Entity Type:Individual
Prefix:
First Name:ZAKIR
Middle Name:JALAL
Last Name:KHANZADA
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 1:3020 HOSPITAL DR
Mailing Address - Street 2:STE. 265
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1962
Mailing Address - Country:US
Mailing Address - Phone:513-735-1529
Mailing Address - Fax:513-732-8537
Practice Address - Street 1:3020 HOSPITAL DR
Practice Address - Street 2:STE. 265
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1962
Practice Address - Country:US
Practice Address - Phone:513-735-1529
Practice Address - Fax:513-732-8537
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.090273207R00000X, 207RG0300X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2841107Medicaid
OHP00856790OtherMEDICARE RR
OHH226300Medicare PIN
OH2841107Medicaid
OHP00856790OtherMEDICARE RR