Individual
MUKARRAM ALI KHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
200 MEDICAL CENTER DR STE 325, MIDDLETOWN, OH 45005-5178
(513) 708-7620
(513) 705-7065
Mailing address
3170 KETTERING BLVD BLDG B, MORAINE, OH 45439-1924
(937) 991-3188
(937) 223-9811
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
34.008823
OH
208VP0014X
Interventional Pain Medicine Physician
Primary
13249
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000488997
ANTHEM
OH
05
—
2679703
—
OH
01
—
7001837
AETNA
OH
05
—
7100217010
—
KY
Enumeration date
08/28/2006
Last updated
04/13/2026
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