Provider Demographics
NPI:1710974076
Name:KHOURY, PHILIP FARID (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:FARID
Last Name:KHOURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1010 CARONDELET DR
Mailing Address - Street 2:STE 220
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4822
Mailing Address - Country:US
Mailing Address - Phone:816-523-0103
Mailing Address - Fax:816-361-6471
Practice Address - Street 1:1010 CARONDELET DR
Practice Address - Street 2:STE 220
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4822
Practice Address - Country:US
Practice Address - Phone:816-523-0103
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030091802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208765701Medicaid
H85767Medicare UPIN