Healthcare Provider Details

I. General information

NPI: 1235662370
Provider Name (Legal Business Name): KEVIN PAUL KHOURY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 SHEFFIELD LN
OAK BROOK IL
60523-2353
US

IV. Provider business mailing address

53 SHEFFIELD LN
OAK BROOK IL
60523-2353
US

V. Phone/Fax

Practice location:
  • Phone: 312-493-9115
  • Fax: 847-733-5108
Mailing address:
  • Phone: 312-493-9115
  • Fax: 312-680-0698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036152251
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number101870
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036152251
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036152251
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: