MEDICARE: UNIVERSITY PARKWAY MEDICAL CLINIC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME0055732	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110098404	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09766	OTHER		BLUE CROSS

General Provider Information

NPI Number	:	1457546897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY PARKWAY MEDICAL CLINIC, INC

Provider Business Mailing Address
First Line	:	3231 GULF GATE DR
Second Line	:	SUITE #101
City	:	SARASOTA
State	:	FL
Zip	:	34231-2406
Country	:	US
Telephone Number	:	941-922-2340
Fax Number	:	941-922-2081

Provider Business Practice Location Address
First Line	:	3231 GULF GATE DR
Second Line	:	SUITE #101
City	:	SARASOTA
State	:	FL
Zip	:	34231-2406
Country	:	US
Telephone Number	:	941-922-2340
Fax Number	:	941-922-2081

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUHAIL A KHOURY
Credential	:	PH.D., M.D.
Telephone Number	:	941-922-2340

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	02/22/2016

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Directions to “UNIVERSITY PARKWAY MEDICAL CLINIC, INC ” Practice Location

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