MEDICARE: HARRY KOURLIS JR. 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
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	261617	MA
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	E11786	AR
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	35.122089	OR
4	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	122089	OH
5	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	35.122089	OH
6	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	MD60593168	WA
7	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	J2453	TX

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	:	1902865678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRY KOURLIS JR. MD

Provider Business Mailing Address
First Line	:	2604 SAINT MICHAEL DR STE 425
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-2378
Country	:	US
Telephone Number	:	903-614-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2604 SAINT MICHAEL DR STE 425
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-2378
Country	:	US
Telephone Number	:	903-614-5630
Fax Number	:

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	03/26/2026

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