Provider Demographics
NPI:1023175056
Name:KHOURY, EDGARD (MD)
Entity type:Individual
Prefix:
First Name:EDGARD
Middle Name:
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 1:800 BIESTERFIELD RD
Mailing Address - Street 2:DEPT OF ANESTHESIA
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3311
Mailing Address - Country:US
Mailing Address - Phone:847-495-1603
Mailing Address - Fax:847-537-4866
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3311
Practice Address - Country:US
Practice Address - Phone:847-437-5500
Practice Address - Fax:847-981-5589
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078210207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0161919966OtherBLUE SHIELD
IL131983700OtherUS DEPT OF LABOR WC
IL036078210 1Medicaid
IL050028402OtherRAILROAD MEDICARE