Provider Demographics
NPI:1518975507
Name:KHOURY, RIAD GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:RIAD
Middle Name:GEORGE
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 1:28521 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2934
Mailing Address - Country:US
Mailing Address - Phone:248-987-6190
Mailing Address - Fax:248-987-6193
Practice Address - Street 1:28521 ORCHARD LAKE RD
Practice Address - Street 2:SUITE C
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2934
Practice Address - Country:US
Practice Address - Phone:248-987-6190
Practice Address - Fax:248-987-6193
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRK038502207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P0400Medicare PIN
A78366Medicare UPIN