Provider Demographics
NPI:1942280441
Name:KHAZAN, URI (MD)
Entity Type:Individual
Prefix:MR
First Name:URI
Middle Name:
Last Name:KHAZAN
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 1:2737 NAVARRE
Mailing Address - Street 2:BLDG B SUITE # 204
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3102
Mailing Address - Country:US
Mailing Address - Phone:419-697-0011
Mailing Address - Fax:419-697-7773
Practice Address - Street 1:2737 NAVARRE
Practice Address - Street 2:BLDG B SUITE # 204
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3102
Practice Address - Country:US
Practice Address - Phone:419-697-0011
Practice Address - Fax:419-697-7773
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059212207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1117911OtherBUREAU OF WORKERS COMP
OH35059212OtherSTATE LICENSE FEDERAL GOV
OH0843289Medicaid
OH0843289Medicaid
1117911OtherBUREAU OF WORKERS COMP
OH0843289Medicaid