Basic Information
| Provider Information | |||||||||
| NPI: | 1285842468 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHOURY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 370 N 120TH AVE | ||||||||
| Address2: | |||||||||
| City: | HOLLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494242196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163965855 | ||||||||
| FaxNumber: | 6163965720 | ||||||||
| Practice Location | |||||||||
| Address1: | 370 N 120TH AVE | ||||||||
| Address2: | |||||||||
| City: | HOLLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494242196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163965855 | ||||||||
| FaxNumber: | 6163965720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2007 | ||||||||
| LastUpdateDate: | 02/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD19196 | ME | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 4301081855 | MI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0004X | 4301081855 | MI | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
No ID Information.