Individual
WISSAM E KHOURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2351 E 22ND ST, CLEVELAND, OH 44115
(216) 367-9444
(216) 453-0331
Mailing address
429 FRONT ST, BEREA, OH 44017-1716
(216) 367-9444
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
36003289
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2487116
—
OH
Enumeration date
03/24/2006
Last updated
03/22/2016
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