Provider Demographics
NPI:1861694341
Name:HENDI, TALIEH (MD)
Entity type:Individual
Prefix:
First Name:TALIEH
Middle Name:
Last Name:HENDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 N FAIRFIELD RD. STE 110
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2645
Mailing Address - Country:US
Mailing Address - Phone:937-426-0106
Mailing Address - Fax:937-426-7153
Practice Address - Street 1:1425 N FAIRFIELD RD STE 110
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2674
Practice Address - Country:US
Practice Address - Phone:937-426-0106
Practice Address - Fax:937-426-7153
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.091928207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2915519Medicaid
OH2915519Medicaid
OH4254622Medicare PIN