Provider Demographics
NPI:1861562365
Name:KHOURY, RANA (MD)
Entity type:Individual
Prefix:DR
First Name:RANA
Middle Name:
Last Name:KHOURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3736 PELHAM ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3832
Mailing Address - Country:US
Mailing Address - Phone:313-565-5101
Mailing Address - Fax:313-565-8001
Practice Address - Street 1:3736 PELHAM ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3832
Practice Address - Country:US
Practice Address - Phone:313-565-5101
Practice Address - Fax:313-565-8001
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080194627OtherRAILROAD MEDICARE
MI1861562365Medicaid
MI0808257481OtherBCN IND
MI0808257481OtherBCBS IND PIN
MI080194627OtherRAILROAD MEDICARE
MIN57640001Medicare PIN