MEDICARE: DR. RICHARD JAMES KOURI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	20619	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164419677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD JAMES KOURI M.D.

Provider Business Mailing Address
First Line	:	1715 N WEBER ST STE 120
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-7524
Country	:	US
Telephone Number	:	719-577-4200
Fax Number	:	719-442-6595

Provider Business Practice Location Address
First Line	:	1715 N WEBER ST STE 120
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-7524
Country	:	US
Telephone Number	:	719-577-4200
Fax Number	:	719-442-6595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	10/17/2012

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