Provider Demographics
NPI:1225232655
Name:RANA KHOURY MD PC
Entity Type:Organization
Organization Name:RANA KHOURY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-565-5101
Mailing Address - Street 1:3736 PELHAM ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3832
Mailing Address - Country:US
Mailing Address - Phone:313-565-5101
Mailing Address - Fax:313-565-8001
Practice Address - Street 1:3736 PELHAM ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3832
Practice Address - Country:US
Practice Address - Phone:313-565-5101
Practice Address - Fax:313-565-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1225232655Medicaid
080H239740OtherBCN GROUP
MI080H239740OtherBCBS GROUP
MIDP0222OtherRAILROAD MEDICARE
MI080H239740OtherBCBS GROUP
MI1225232655Medicaid