Provider Demographics
NPI:1760459978
Name:KHURI, GEORGE M (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:M
Last Name:KHURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MUNTHER
Other - Middle Name:G
Other - Last Name:KHURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15800 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3748
Mailing Address - Country:US
Mailing Address - Phone:216-226-8700
Mailing Address - Fax:216-221-3171
Practice Address - Street 1:15800 DETROIT AVE
Practice Address - Street 2:STE 400
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3748
Practice Address - Country:US
Practice Address - Phone:216-226-8700
Practice Address - Fax:216-221-3171
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074781K207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D368301OtherGROUP IND DIAGNOSTICS MED
OH2120323Medicaid
9273172OtherGROUP MEDICARE
110244825OtherRR MEDICARE INDIVIDUAL
3610861OtherGROUP ASC MEDICARE
10794268OtherCAQH
0119204OtherGROUP MEDICAID
1780634279OtherGROUP NPI
CA4511OtherRR MEDICARE GROUP
3610861OtherGROUP ASC MEDICARE
H00277Medicare UPIN
OH2120323Medicaid