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General NPI Number Information
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NPI Number | 1851415798
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Entity Type | Individual
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Provider Name | HABIB JOSEPH KHOURY M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/17/2007
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Last Update Date | 06/14/2012
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Provider Practice Location Address
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Address Line | 25200 CENTER RIDGE RD #3300
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City | WESTLAKE
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State | OH
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Zip | 44145-4141
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Country | US
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Telephone | 440-331-3645
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Fax |
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Provider Business Mailing Address
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Address Line | 20525 CENTER RIDGE RD SUITE 220
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City | ROCKY RIVER
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State | OH
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Zip | 44116-3437
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Country | US
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Telephone | 440-895-5056
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 88982
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2082S0099X
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Taxonomy Name | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
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License Number | 88982
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number | 88982
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License Number State | OH
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