Provider Demographics
NPI:1699718825
Name:MERCHANT, KETAN D (DO)
Entity type:Individual
Prefix:DR
First Name:KETAN
Middle Name:D
Last Name:MERCHANT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4417 LEVI TODD BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4505
Mailing Address - Country:US
Mailing Address - Phone:859-402-8331
Mailing Address - Fax:
Practice Address - Street 1:3130 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1337
Practice Address - Country:US
Practice Address - Phone:937-440-4600
Practice Address - Fax:937-339-4056
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008219207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2564283Medicaid
I32388Medicare UPIN
ME4160731Medicare ID - Type Unspecified