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General NPI Number Information
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NPI Number | 1295064343
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Entity Type | Organization
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Legal Business Name | WISSAM KHOURY DPM LLC
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Dates
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Enumeration Date | 12/21/2009
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 2351 E 22ND ST
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City | CLEVELAND
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State | OH
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Zip | 44115
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Country | US
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Telephone | 216-367-9444
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Fax | 216-453-0331
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Provider Business Mailing Address
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Address Line | 429 FRONT ST
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City | BEREA
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State | OH
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Zip | 44017-1716
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Country | US
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Telephone | 216-367-9444
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WISSAM KHOURY
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Credential | DPM
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Telephone | 216-921-3668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36003289
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License Number State | OH
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