Healthcare Provider Details

I. General information

NPI: 1952582579
Provider Name (Legal Business Name): FUAD ALKHOURY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SW 60TH CT SUITE 201
MIAMI FL
33155-4000
US

IV. Provider business mailing address

3200 SW 60TH CT SUITE 201
MIAMI FL
33155-4000
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-8320
  • Fax: 305-662-8202
Mailing address:
  • Phone: 305-662-8320
  • Fax: 305-662-8202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberME-107957
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: