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General NPI Number Information
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NPI Number | 1144310756
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Entity Type | Individual
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Provider Name | PETER CRIST KOURETAS MD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 550 16TH ST FL 5
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City | SAN FRANCISCO
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State | CA
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Zip | 94143
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Country | US
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Telephone | 415-476-3535
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Fax | 415-476-3535
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Provider Business Mailing Address
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Address Line | 550 16TH ST FL 5
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City | SAN FRANCISCO
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State | CA
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Zip | 94143-2549
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Country | US
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Telephone | 415-476-3535
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Fax | 415-476-5365
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 35-096431
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License Number State | OH
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