Provider Demographics
NPI:1609086081
Name:KHOURY, CHRISTINA MARY (CHRISTINA KHOURY MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MARY
Last Name:KHOURY
Suffix:
Gender:F
Credentials:CHRISTINA KHOURY MD
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:MARY
Other - Last Name:KHOURY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHRISTINA KHOURY
Mailing Address - Street 1:9250 N 3RD ST
Mailing Address - Street 2:SITE 4010
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2437
Mailing Address - Country:US
Mailing Address - Phone:602-633-3848
Mailing Address - Fax:602-633-3841
Practice Address - Street 1:9250 N 3RD ST
Practice Address - Street 2:SUITE 2030
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2437
Practice Address - Country:US
Practice Address - Phone:623-882-1292
Practice Address - Fax:623-882-8184
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087966207X00000X
AZ46587207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86-0783428OtherTAX-ID
AZ711210Medicaid
AZZ137891Medicare PIN