Provider Demographics
NPI:1083606008
Name:KOURIE, MICHEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:A
Last Name:KOURIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 637676
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:513-528-5600
Mailing Address - Fax:513-528-9716
Practice Address - Street 1:463 OHIO PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-3721
Practice Address - Country:US
Practice Address - Phone:513-528-5600
Practice Address - Fax:513-528-9716
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2093710Medicaid
OH0859846Medicare PIN
OH2093710Medicaid