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NPI Code Detail

MEDICARE: CALIFORNIA EMERGENCY PHYSICIANS MEDICAL GROUP, A PROFESSIONAL CORP.

MEDICARE: CALIFORNIA EMERGENCY PHYSICIANS MEDICAL GROUP, A PROFESSIONAL CORP.
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
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1306210554
Entity Type Code : Organization
Provider Name (Legal Business Name) : CALIFORNIA EMERGENCY PHYSICIANS MEDICAL GROUP, A PROFESSIONAL CORP.
Provider Business Mailing Address
First Line : 2100 POWELL ST
Second Line : STE 900
City : EMERYVILLE
State : CA
Zip : 94608-1826
Country : US
Telephone Number : 510-350-2600
Fax Number :
Provider Business Practice Location Address
First Line : 9106 PINE VIEW LN
Second Line :
City : CLINTON
State : MD
Zip : 20735-3229
Country : US
Telephone Number : 410-880-4353
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : THEOPHILE KOURY
Credential : M.D
Telephone Number : 510-350-2600
Provider Enumeration Date : 11/25/2015
Last Update Date : 02/06/2018

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