Healthcare Provider Details

I. General information

NPI: 1194804203
Provider Name (Legal Business Name): DANIEL J KHOURY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7803 APTON RD
WOODBURY MN
55125
US

IV. Provider business mailing address

7803 APTON RD
WOODBURY MN
55125
US

V. Phone/Fax

Practice location:
  • Phone: 651-738-0470
  • Fax: 651-738-8915
Mailing address:
  • Phone: 651-788-0470
  • Fax: 651-738-8915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39102
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: