Wissam Khoury DPM LLC
Organization Active NPI Podiatrist · Cleveland, OH
NPI 1295064343 · NPPES record last updated Sep 8, 2026
Key facts
- NPI
- 1295064343
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatrist 213E00000X
- License
- 36003289 (OH)
- Legal business name
- WISSAM KHOURY DPM LLC
- Practice address
- 2475 E 22ND St Ste 120
Cleveland, OH 44115-3221 - Phone
- (216) 367-9444
- NPI assigned
- Dec 21, 2009
- Organization subpart
- No
Authorized official
- Name
- Wissam Khoury, DPM
- Title
- Owner
- Phone
- (216) 921-3668
Practitioners 24
-
Rae-Anna Johnson, FNP-C
-
Renee Sferra, CNS
-
Vaquet A Shomo-Brown, CNP
-
Amy Canini, APRN, FNP-C
-
Wissam E Khoury, DPM
-
Sarah Anne Lockwood, CNP
-
Suneeta Rai, ACNS, FNP
-
Angela Marie Rogers, FNP-C
-
Diane L Weaver, DNP
-
Lisa Shaheen, NP
-
Robin Diane Stone, RN, FNP-C
-
Allison Beth Neal, CNP
-
Paula F Abbott, CNP
-
Tracy Patterson Delk, DNP, APRN, FNP-BC
-
Sherry L. Flannery, NP-C
-
Robyn Chesney, FNP-BC
-
Lacrista Venable, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100310000565 | OH | Part B Supplier - Clinic/Group Practice | 2668517061 |
Receives reassigned benefits from 15 practitioners Practice locations: Cleveland, OH |
National Provider Directory
Locations
3487 Center Rd
Ste 4
Brunswick, OH 44212
Phone (330) 225-7520
8300 Tyler Blvd
Ste 102
Mentor, OH 44060
Phone (440) 205-0242
33001 Solon Rd
Ste 112
Solon, OH 44139
Phone (440) 248-1297
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist |
213E00000X | 36003289 | OH | Yes |
Addresses
Primary practice location
2475 E 22ND St Ste 120
Cleveland, OH 44115-3221
Mailing address
2475 E 22ND St Ste 120
Cleveland, OH 44115-3221
Phone (216) 367-9444
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3052468 | Medicaid | OH |
Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.