Provider Demographics
NPI:1114050499
Name:RIAD G KHOURY PC
Entity Type:Organization
Organization Name:RIAD G KHOURY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIAD
Authorized Official - Middle Name:G
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-987-6190
Mailing Address - Street 1:28521 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2934
Mailing Address - Country:US
Mailing Address - Phone:248-987-6190
Mailing Address - Fax:248-987-6193
Practice Address - Street 1:28521 ORCHARD LAKE RD STE C
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2934
Practice Address - Country:US
Practice Address - Phone:248-987-6190
Practice Address - Fax:248-987-6193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038502207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI050F353180OtherBCN GRP
MI6805110001OtherDME PTAN
MI050F353180OtherBCBS GRP
MI1114050499Medicaid
MI050F353180OtherBCN GRP
MI1114050499Medicaid
MI6805110001OtherDME PTAN