Individual
JODI BETH KHOURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
676 N SAINT CLAIR ST STE 2000, CHICAGO, IL 60611-3147
(312) 695-5620
(312) 695-7095
Mailing address
676 N SAINT CLAIR ST STE 2000, CHICAGO, IL 60611-3147
(312) 695-5620
(312) 695-7095
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085002427
IL
363A00000X
Physician Assistant
6833
AZ
363AM0700X
Medical Physician Assistant
085.002427
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-002427
IL STATE LIC
IL
Enumeration date
05/29/2007
Last updated
09/19/2023
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