Provider Demographics
NPI:1265469837
Name:M.STEVEN KHOURY
Entity type:Organization
Organization Name:M.STEVEN KHOURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:989-673-3338
Mailing Address - Street 1:P.O. BOX 349, 150 MILLWOOD ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48744-1656
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMK001200213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2828096Medicaid
MI2828096Medicaid
MIT34054Medicare UPIN