Provider Demographics
NPI:1275567133
Name:SUSANA LEAL-KHOURI, MDPA
Entity Type:Organization
Organization Name:SUSANA LEAL-KHOURI, MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:MIRTA
Authorized Official - Last Name:LEAL-KHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-361-8200
Mailing Address - Street 1:580 CRANDON BLVD#101
Mailing Address - Street 2:
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-1399
Mailing Address - Country:US
Mailing Address - Phone:305-361-8200
Mailing Address - Fax:305-361-8005
Practice Address - Street 1:580 CRANDON BLVD#101
Practice Address - Street 2:
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-1399
Practice Address - Country:US
Practice Address - Phone:305-361-8200
Practice Address - Fax:305-361-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1199Medicare ID - Type Unspecified