Provider Demographics
NPI:1063638682
Name:COURIS, MICHAEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:COURIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3969 4TH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3165
Mailing Address - Country:US
Mailing Address - Phone:619-291-6191
Mailing Address - Fax:619-291-0049
Practice Address - Street 1:3969 4TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3165
Practice Address - Country:US
Practice Address - Phone:619-291-6191
Practice Address - Fax:619-291-0049
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA53265207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A532651OtherMEDICARE-SPECTRUM
CA180046485OtherPALMETTO GBA
CAA53265BOtherMEDICARE PIN-SPECTRUM
CA00A532651OtherMEDI-CAL SPECTRUM
CA180046485OtherRR MEDICARE
CAP00353462OtherRAILROAD MEDICARE
CA00A532650Medicaid
CA522450085OtherTAX ID
CA00A532650OtherBLUE SHIELD
CA4401850001OtherDMERC
CA5224500859210300OtherCHAMPUS
CA00A532651OtherMEDI-CAL SPECTRUM
CA4401850001OtherDMERC
CA522450085OtherTAX ID