Healthcare Provider Details

I. General information

NPI: 1861012973
Provider Name (Legal Business Name): MICHAEL A LOURIE MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2020
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST STE 16-738
CHICAGO IL
60611-3055
US

IV. Provider business mailing address

200 TRENT DR
DURHAM NC
27710-3037
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-5924
  • Fax: 312-926-6134
Mailing address:
  • Phone: 919-684-3491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125.075868
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036168785
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.075868
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number036168785
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: