Provider Demographics
NPI:1740591155
Name:KHOURY, SPIRO ADEL (MD)
Entity Type:Individual
Prefix:
First Name:SPIRO
Middle Name:ADEL
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 1:430 HAWKINS RUN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-6660
Mailing Address - Country:US
Mailing Address - Phone:469-964-0641
Mailing Address - Fax:833-941-2603
Practice Address - Street 1:430 HAWKINS RUN RD STE 1
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-6660
Practice Address - Country:US
Practice Address - Phone:469-964-7635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ7220207L00000X, 207LP2900X
WI4020-320207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100268403Medicaid