MEDICARE: GEORGE M KHURI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35074781K	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
3	9273172	OTHER	GROUP MEDICARE
4	110244825	OTHER	RR MEDICARE INDIVIDUAL
5	3610861	OTHER	GROUP ASC MEDICARE
9	CA4511	OTHER	RR MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	D368301	OTHER	GROUP IND DIAGNOSTICS MED
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	10794268	OTHER	CAQH
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	1780634279	OTHER	GROUP NPI

General Provider Information

NPI Number	:	1760459978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE M KHURI MD

Provider Business Mailing Address
First Line	:	15800 DETROIT AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-3748
Country	:	US
Telephone Number	:	216-226-8700
Fax Number	:	216-221-3171

Provider Business Practice Location Address
First Line	:	15800 DETROIT AVE
Second Line	:	STE 400
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-3748
Country	:	US
Telephone Number	:	216-226-8700
Fax Number	:	216-221-3171

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	03/28/2024

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Directions to “ GEORGE M KHURI MD” Practice Location

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