Provider Demographics
NPI:1518922004
Name:KHOURI LABORATORIES, INC
Entity Type:Organization
Organization Name:KHOURI LABORATORIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAL-KHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-361-5635
Mailing Address - Street 1:180 CRANDON BLVD
Mailing Address - Street 2:STE #114
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149
Mailing Address - Country:US
Mailing Address - Phone:305-361-3086
Mailing Address - Fax:305-361-0633
Practice Address - Street 1:180 CRANDON BLVD
Practice Address - Street 2:STE #114
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149
Practice Address - Country:US
Practice Address - Phone:305-361-3086
Practice Address - Fax:305-361-0633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800013149207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL9096OtherBCBS
FLL9096OtherBCBS