Provider Demographics
NPI:1962469452
Name:MANZAR, KHALID JALIL (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALID
Middle Name:JALIL
Last Name:MANZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 73652
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0002
Mailing Address - Country:US
Mailing Address - Phone:859-313-2758
Mailing Address - Fax:859-276-5939
Practice Address - Street 1:1210 W 5TH ST
Practice Address - Street 2:STE 100
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2112
Practice Address - Country:US
Practice Address - Phone:606-864-4040
Practice Address - Fax:606-864-3500
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34308207RC0000X
PAMD457745207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0193OtherJOHN DEERE HEALTH
IA0247221Medicaid
67134OtherIOWA HEALTH SOLUTIONS
43330OtherWELLMARK BC/BS
060067839OtherRAILROAD MEDICARE
235475OtherMIDLANDS CHOICE
071725OtherHEALTH ALLIANCE
060067839OtherRAILROAD MEDICARE