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General NPI Number Information
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NPI Number | 1194825190
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Entity Type | Organization
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Legal Business Name | THOMAS F KOURI INTERNAL MEDICINE INC
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 06/11/2013
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Provider Practice Location Address
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Address Line | 5401 N KNOXVILLE AVE
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City | PEORIA
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State | IL
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Zip | 61614-5098
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Country | US
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Telephone | 309-689-9088
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Fax | 309-689-9072
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Provider Business Mailing Address
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Address Line | 5401 N KNOXVILLE AVE SUITE 212
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City | PEORIA
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State | IL
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Zip | 61614-5098
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Country | US
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Telephone | 309-689-6049
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Fax | 309-689-6092
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | THOMAS KOURI
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Credential | MD
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Telephone | 309-689-9088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036071029
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License Number State | IL
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