Provider Demographics
NPI:1497836548
Name:KHOURY, NABIL E (MD)
Entity Type:Individual
Prefix:
First Name:NABIL
Middle Name:E
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:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:6777 WEST MAPLE ROAD
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323
Mailing Address - Country:US
Mailing Address - Phone:248-661-6450
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:6777 WEST MAPLE ROAD
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323
Practice Address - Country:US
Practice Address - Phone:248-661-6450
Practice Address - Fax:248-661-6649
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054261207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NK054261OtherCOMMERCIAL-COMMERCIAL NUMBER
NK054261OtherCHAMPUS-CHAMPUS
MI308038210Medicaid
010H262530OtherBLUE CROSS-BLUE CROSS
NK054261OtherCOMMERCIAL-COMMERCIAL NUMBER
MI308038210Medicaid