Provider Demographics
NPI:1245227552
Name:KHOURY, WAEL (MD)
Entity Type:Individual
Prefix:
First Name:WAEL
Middle Name:
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 1:12000 MCCRACKEN RD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2964
Mailing Address - Country:US
Mailing Address - Phone:216-475-5370
Mailing Address - Fax:216-475-5125
Practice Address - Street 1:12000 MCCRACKEN RD
Practice Address - Street 2:SUITE 460
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2964
Practice Address - Country:US
Practice Address - Phone:216-475-5370
Practice Address - Fax:216-475-5125
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH041897207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0461692Medicaid
OHKH0493693Medicare ID - Type Unspecified
OH0461692Medicaid