Provider Demographics
NPI:1104128206
Name:KHOURY, ALLAN T (MD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:T
Last Name:KHOURY
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 1:1375 E 9TH ST FL 11
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-1753
Mailing Address - Country:US
Mailing Address - Phone:216-344-5542
Mailing Address - Fax:216-589-9445
Practice Address - Street 1:1375 E 9TH ST FL 11
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-1753
Practice Address - Country:US
Practice Address - Phone:216-344-5542
Practice Address - Fax:216-589-9445
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH049028207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E97316Medicare UPIN