Healthcare Provider Details

I. General information

NPI: 1871589168
Provider Name (Legal Business Name): SUSANA LEAL-KHOURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSANA LEAL-KHOURI MD

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 CRANDON BLVD # 101
KEY BISCAYNE FL
33149-1832
US

IV. Provider business mailing address

580 CRANDON BLVD # 101
KEY BISCAYNE FL
33149-1832
US

V. Phone/Fax

Practice location:
  • Phone: 305-361-8200
  • Fax: 305-572-7035
Mailing address:
  • Phone: 305-361-8200
  • Fax: 305-572-7035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberME46173
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License NumberME46173
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: