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General NPI Number Information
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NPI Number | 1891773321
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Entity Type | Individual
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Provider Name | THEODORE KYPREOS KOUTOUZIS MD
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Gender | Male
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 10/10/2017
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Provider Practice Location Address
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Address Line | 211 E ONTARIO ST
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City | CHICAGO
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State | IL
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Zip | 60611-3468
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Country | US
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Telephone | 312-694-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 211 E ONTARIO
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City | CHICAGO
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State | IL
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Zip | 60611
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Country | US
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Telephone | 312-694-7000
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036-102893
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License Number State | IL
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