Provider Demographics
NPI:1245276351
Name:KHOURY, MARK STEVEN (DPM)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:KHOURY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-0349
Mailing Address - Country:US
Mailing Address - Phone:989-673-3338
Mailing Address - Fax:989-673-0112
Practice Address - Street 1:150 MILLWOOD ST
Practice Address - Street 2:SUITE A
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1656
Practice Address - Country:US
Practice Address - Phone:989-673-3338
Practice Address - Fax:989-673-0112
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMK0021200213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2828096Medicaid
MI2828096Medicaid
MIT34054Medicare UPIN
MI0389140001Medicare NSC