Provider Demographics
NPI:1255357943
Name:EL-KHOURY, MAROUN E (MD)
Entity type:Individual
Prefix:DR
First Name:MAROUN
Middle Name:E
Last Name:EL-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 1:1225 S GEAR AVE
Mailing Address - Street 2:SUITE 152
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1691
Mailing Address - Country:US
Mailing Address - Phone:319-753-1220
Mailing Address - Fax:319-753-5464
Practice Address - Street 1:1225 S GEAR AVE
Practice Address - Street 2:SUITE 152
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1691
Practice Address - Country:US
Practice Address - Phone:319-753-1220
Practice Address - Fax:319-753-5464
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36404207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0490573Medicaid
IA36404OtherSTATE MEDICAL LICENSE NUM
IA36404OtherSTATE MEDICAL LICENSE NUM
IAI17497Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER