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General NPI Number Information
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NPI Number | 1831576693
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Entity Type | Individual
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Provider Name | BISHARA ROBERT KHOURY D.O
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Gender | Male
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 03/25/2023
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Provider Practice Location Address
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Address Line | 3545 ARBOR BLVD STE E
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City | PORTAGE
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State | IN
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Zip | 46368
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Country | US
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Telephone | 219-947-6920
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Fax | 219-947-6921
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Provider Business Mailing Address
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Address Line | 53 SHEFFIELD LN
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City | OAK BROOK
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State | IL
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Zip | 60523-2353
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Country | US
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Telephone | 331-645-6029
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02005157A
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License Number State | IN
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