Provider Demographics
NPI:1831576693
Name:KHOURY, BISHARA ROBERT (DO)
Entity type:Individual
Prefix:
First Name:BISHARA
Middle Name:ROBERT
Last Name:KHOURY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:KHOURY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:53 SHEFFIELD LN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2353
Mailing Address - Country:US
Mailing Address - Phone:331-645-6029
Mailing Address - Fax:
Practice Address - Street 1:3545 ARBOR BLVD STE E
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368
Practice Address - Country:US
Practice Address - Phone:219-947-6920
Practice Address - Fax:219-947-6921
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005157A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine