Provider Demographics
NPI:1578618674
Name:KHOURY, ZIYADEH MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:ZIYADEH
Middle Name:MICHAEL
Last Name:KHOURY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3636
Mailing Address - Country:US
Mailing Address - Phone:810-720-1730
Mailing Address - Fax:810-720-1736
Practice Address - Street 1:1051 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3636
Practice Address - Country:US
Practice Address - Phone:810-720-1730
Practice Address - Fax:810-720-1736
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010658207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2942887Medicaid
MIF59747Medicare UPIN
MI2942887Medicaid