Provider Demographics
NPI:1578543849
Name:KHOURY, SLEMAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:SLEMAN
Middle Name:A
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 1:15125 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2409
Mailing Address - Country:US
Mailing Address - Phone:734-282-3138
Mailing Address - Fax:734-282-1969
Practice Address - Street 1:15125 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2409
Practice Address - Country:US
Practice Address - Phone:734-282-3138
Practice Address - Fax:734-282-1969
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI46311207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1108221861OtherBCBS
MI460000848OtherMEDICARERR
MI2665894Medicaid
MI2665894Medicaid
MI0822186Medicare PIN