Provider Demographics
NPI:1083926232
Name:KHOURY, PHILIP (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:KHOURY
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 1:3975 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1510
Mailing Address - Country:US
Mailing Address - Phone:248-459-0314
Mailing Address - Fax:
Practice Address - Street 1:3850 RIVERLAKES DR STE B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-6662
Practice Address - Country:US
Practice Address - Phone:661-241-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-04
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018777207L00000X
CA20A14690207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology