Provider Demographics
NPI:1558324442
Name:KHOURI, ELIE JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIE
Middle Name:JOSEPH
Last Name:KHOURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIE
Other - Middle Name:JOSEPH
Other - Last Name:AWAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3392 TABREEZE CT
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4600
Mailing Address - Country:US
Mailing Address - Phone:407-341-8970
Mailing Address - Fax:
Practice Address - Street 1:1701 LACEY ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-5230
Practice Address - Country:US
Practice Address - Phone:573-331-6431
Practice Address - Fax:573-986-5984
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64138207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002584800Medicaid
FL23412XMedicare PIN
FL002584800Medicaid