Provider Demographics
NPI:1629273040
Name:H. MICHAEL KHOURY, MD,LLC
Entity Type:Organization
Organization Name:H. MICHAEL KHOURY, MD,LLC
Other - Org Name:RAINBOW PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HABIB
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-349-6641
Mailing Address - Street 1:PO BOX 43534
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40253-0534
Mailing Address - Country:US
Mailing Address - Phone:502-349-6641
Mailing Address - Fax:502-349-6642
Practice Address - Street 1:107 MANOR AVE STE 205
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2800
Practice Address - Country:US
Practice Address - Phone:502-349-6641
Practice Address - Fax:502-349-6642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-16
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34774208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH28208Medicare UPIN