MEDICARE: NEIL CHRISTIAN KHOURY MD

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	207RG0100X	Gastroenterology Physician	ME170933	FL
2	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TPH4U	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760941801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL CHRISTIAN KHOURY MD

Provider Business Mailing Address
First Line	:	PO BOX 917770
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-0001
Country	:	US
Telephone Number	:	813-821-8038
Fax Number	:

Provider Business Practice Location Address
First Line	:	263 FARMINGTON AVE
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06030-4905
Country	:	US
Telephone Number	:	860-679-3238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	12/07/2025

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