Provider Demographics
NPI:1184247520
Name:KHOURI, TATUM YVONNE (MD)
Entity type:Individual
Prefix:
First Name:TATUM
Middle Name:YVONNE
Last Name:KHOURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TATUM
Other - Middle Name:YVONNE
Other - Last Name:ZURAWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5299
Mailing Address - Fax:
Practice Address - Street 1:380 PARKLAND PLZ
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6201
Practice Address - Country:US
Practice Address - Phone:734-539-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301509179208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics