Provider Demographics
NPI:1639135973
Name:KHOURY, SAEB FOUAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SAEB
Middle Name:FOUAD
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-287-3045
Mailing Address - Fax:859-578-3800
Practice Address - Street 1:711 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-287-3045
Practice Address - Fax:859-578-3800
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063530207RI0011X
KY36977207RI0011X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000536968OtherANTHEM
OH283440OtherAMERIGROUP
OH2287369Medicaid
OH2287369OtherMOLINA HEALTHCARE
KY64038722Medicaid
OHP01142325OtherRR MEDICARE
OH208679830032OtherCARESOURCE
IN200348590Medicaid
OH000000536968OtherANTHEM
IN200348590Medicaid
OHKH4059846Medicare PIN
OHP01142325OtherRR MEDICARE
OH208679830032OtherCARESOURCE