Provider Demographics
NPI:1235662370
Name:KHOURY, KEVIN PAUL (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:PAUL
Last Name:KHOURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 SHEFFIELD LN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2353
Mailing Address - Country:US
Mailing Address - Phone:312-493-9115
Mailing Address - Fax:312-680-0698
Practice Address - Street 1:53 SHEFFIELD LN
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2353
Practice Address - Country:US
Practice Address - Phone:312-493-9115
Practice Address - Fax:847-733-5108
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036152251207R00000X, 208M00000X, 207RG0100X
WI101870207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100282412Medicaid