Provider Demographics
NPI:1043492671
Name:GEORGE KOURIS MD SC
Entity Type:Organization
Organization Name:GEORGE KOURIS MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOURIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-432-2850
Mailing Address - Street 1:1611 W HARRISON ST
Mailing Address - Street 2:212
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4861
Mailing Address - Country:US
Mailing Address - Phone:312-432-2850
Mailing Address - Fax:312-563-2545
Practice Address - Street 1:1611 W HARRISON ST
Practice Address - Street 2:212
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4861
Practice Address - Country:US
Practice Address - Phone:312-432-2850
Practice Address - Fax:312-563-2545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
209963Medicare PIN