Provider Demographics
NPI:1457546897
Name:UNIVERSITY PARKWAY MEDICAL CLINIC, INC
Entity Type:Organization
Organization Name:UNIVERSITY PARKWAY MEDICAL CLINIC, INC
Other - Org Name:KHOURY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUHAIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD
Authorized Official - Phone:941-922-2340
Mailing Address - Street 1:3231 GULF GATE DR
Mailing Address - Street 2:SUITE #101
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-2406
Mailing Address - Country:US
Mailing Address - Phone:941-922-2340
Mailing Address - Fax:941-922-2081
Practice Address - Street 1:3231 GULF GATE DR
Practice Address - Street 2:SUITE #101
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-2406
Practice Address - Country:US
Practice Address - Phone:941-922-2340
Practice Address - Fax:941-922-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055732207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
09766OtherBLUE CROSS
110098404OtherRAILROAD MEDICARE
09766OtherBLUE CROSS