Provider Demographics
NPI:1770551301
Name:KHOURI, HANNA MICHEL (MD)
Entity type:Individual
Prefix:DR
First Name:HANNA
Middle Name:MICHEL
Last Name:KHOURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HANNA
Other - Middle Name:MICHEL
Other - Last Name:EL-KHOURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43380 WOODWARD AVE
Mailing Address - Street 2:# 105
Mailing Address - City:BLFLD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302
Mailing Address - Country:US
Mailing Address - Phone:248-335-8500
Mailing Address - Fax:248-335-5430
Practice Address - Street 1:43380 WOODWARD AVE
Practice Address - Street 2:STE 105
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302
Practice Address - Country:US
Practice Address - Phone:248-335-8500
Practice Address - Fax:248-335-5430
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010597892080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3509947Medicaid
MI3509947Medicaid
G84851Medicare UPIN