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NPI Code Detail

MEDICARE: PETER J KOURLAS MD

MEDICARE: PETER J KOURLAS MD
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
1207RH0003XHematology & Oncology Physician35.071006OH

Other Identifiers

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

General Provider Information

NPI Number : 1700882818
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER J KOURLAS MD
Provider Business Mailing Address
First Line : 810 JASONWAY AVE STE A
Second Line :
City : COLUMBUS
State : OH
Zip : 43214-4359
Country : US
Telephone Number : 614-442-3130
Fax Number : 614-442-3150
Provider Business Practice Location Address
First Line : 810 JASONWAY AVE STE A
Second Line :
City : COLUMBUS
State : OH
Zip : 43214-4359
Country : US
Telephone Number : 614-442-3130
Fax Number : 614-442-3145
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 08/12/2024

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Directions to “ PETER J KOURLAS MD” Practice Location

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