Provider Demographics
NPI:1821472408
Name:KHOURY, HAYTHAM
Entity Type:Individual
Prefix:
First Name:HAYTHAM
Middle Name:
Last Name:KHOURY
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:HAYTHAM
Other - Middle Name:
Other - Last Name:KHOURY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:446 E ONTARIO ST
Mailing Address - Street 2:SUITE 10-1000
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4418
Mailing Address - Country:US
Mailing Address - Phone:312-695-4960
Mailing Address - Fax:312-695-4961
Practice Address - Street 1:446 E ONTARIO ST
Practice Address - Street 2:SUITE 10-1000
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4418
Practice Address - Country:US
Practice Address - Phone:312-695-4960
Practice Address - Fax:312-695-4961
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125066093390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program