Provider Demographics
NPI:1285628313
Name:KHOURI, SAMER J (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:J
Last Name:KHOURI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3355 GLENDALE AVE
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-7100
Mailing Address - Fax:419-383-2000
Practice Address - Street 1:3000 ARLINGTON AVE
Practice Address - Street 2:MEDICINE
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2595
Practice Address - Country:US
Practice Address - Phone:419-383-3925
Practice Address - Fax:419-383-6167
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35076633207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2320321Medicaid
H59304Medicare UPIN
OH2320321Medicaid