Provider Demographics
NPI:1912947763
Name:KHATANA, ANUP K (MD)
Entity Type:Individual
Prefix:DR
First Name:ANUP
Middle Name:K
Last Name:KHATANA
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 1:1945 CEI DRIVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3311
Mailing Address - Country:US
Mailing Address - Phone:513-984-5133
Mailing Address - Fax:513-936-1090
Practice Address - Street 1:1945 CEI DRIVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-3311
Practice Address - Country:US
Practice Address - Phone:513-984-5133
Practice Address - Fax:513-984-4240
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078630207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200304150Medicaid
OH2195888Medicaid
OH180040580OtherRAILROAD MEDICARE
WV3810002904Medicaid
KY64019706Medicaid
000000194855OtherBCBS
TN4046599Medicaid
OH4031773Medicare PIN
IN200304150Medicaid
OH4031774Medicare PIN