Healthcare Provider Details

I. General information

NPI: 1093958720
Provider Name (Legal Business Name): ANTON EDWARD KHOURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 CHEVIOT RD
CINCINNATI OH
45247-7069
US

IV. Provider business mailing address

4685 FOREST AVE STE C
CINCINNATI OH
45212-3397
US

V. Phone/Fax

Practice location:
  • Phone: 513-451-4033
  • Fax: 513-451-1356
Mailing address:
  • Phone: 513-853-4721
  • Fax: 153-852-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35.127169
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: