Healthcare Provider Details

I. General information

NPI: 1841341179
Provider Name (Legal Business Name): GEORGE J KOURIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W HARRISON ST 212
CHICAGO IL
60612-4861
US

IV. Provider business mailing address

1611 W HARRISON ST. 212
CHICAGO IL
60612-3841
US

V. Phone/Fax

Practice location:
  • Phone: 312-432-2850
  • Fax: 312-563-2545
Mailing address:
  • Phone: 312-432-2850
  • Fax: 312-563-2545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number036-108015
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: