Healthcare Provider Details

I. General information

NPI: 1518922004
Provider Name (Legal Business Name): KHOURI LABORATORIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 CRANDON BLVD STE #114
KEY BISCAYNE FL
33149
US

IV. Provider business mailing address

180 CRANDON BLVD STE #114
KEY BISCAYNE FL
33149
US

V. Phone/Fax

Practice location:
  • Phone: 305-361-3086
  • Fax: 305-361-0633
Mailing address:
  • Phone: 305-361-3086
  • Fax: 305-361-0633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number800013149
License Number StateFL

VIII. Authorized Official

Name: SUSANA LEAL-KHOURI
Title or Position: DIRECTOR
Credential: MD
Phone: 305-361-5635