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General NPI Number Information
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NPI Number | 1255957163
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Entity Type | Individual
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Provider Name | COURTNEY MARGARET DE SOUZA MD
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Gender | Female
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 1300 N OAKLAND AVE
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City | BOLIVAR
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State | MO
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Zip | 65613-3042
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Country | US
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Telephone | 417-326-7676
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Fax |
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Provider Business Mailing Address
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Address Line | 5140 N CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60625
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Country | US
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Telephone | 773-878-2000
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Fax | 773-293-5670
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12507687
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2023026723
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License Number State | MO
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