Provider Demographics
NPI:1619964269
Name:KHOURY, ELIE RAMZI (MD)
Entity Type:Individual
Prefix:
First Name:ELIE
Middle Name:RAMZI
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 1:15831 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-3523
Mailing Address - Country:US
Mailing Address - Phone:313-882-2266
Mailing Address - Fax:313-882-4748
Practice Address - Street 1:15831 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-3523
Practice Address - Country:US
Practice Address - Phone:313-882-2266
Practice Address - Fax:313-882-4748
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010311992083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B47617Medicare UPIN
MI08235962161Medicare ID - Type Unspecified