Healthcare Provider Details

I. General information

NPI: 1164419677
Provider Name (Legal Business Name): RICHARD JAMES KOURI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 N WEBER ST STE 120
COLORADO SPRINGS CO
80907-7524
US

IV. Provider business mailing address

1715 N WEBER ST STE 120
COLORADO SPRINGS CO
80907-7524
US

V. Phone/Fax

Practice location:
  • Phone: 719-577-4200
  • Fax: 719-442-6595
Mailing address:
  • Phone: 719-577-4200
  • Fax: 719-442-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20619
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: