Provider Demographics
NPI:1306842620
Name:KHOURY, SUHAIL ADIB (MD)
Entity type:Individual
Prefix:
First Name:SUHAIL
Middle Name:ADIB
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 1:15140 FRUITVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-9364
Mailing Address - Country:US
Mailing Address - Phone:941-448-5773
Mailing Address - Fax:941-845-4963
Practice Address - Street 1:15140 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240
Practice Address - Country:US
Practice Address - Phone:941-448-5773
Practice Address - Fax:941-845-4963
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055732207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110098404OtherRAILROAD MEDICARE
FL77348OtherMEDICARE ID
E86799Medicare UPIN