Healthcare Provider Details

I. General information

NPI: 1891761284
Provider Name (Legal Business Name): BRIAN A COURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SOUTH YORK ST
ELMHURST IL
60126-5626
US

IV. Provider business mailing address

1200 SOUTH YORK ST
ELMHURST IL
60126-5626
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-9095
  • Fax: 331-221-3996
Mailing address:
  • Phone: 331-221-9095
  • Fax: 331-221-3996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number0360966631
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036096663
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: