Provider Demographics
NPI:1093081713
Name:KOUTOUROUSIOU, MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:KOUTOUROUSIOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 ABRAHAM FLEXNER WAY
Mailing Address - Street 2:STE #1200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2877
Mailing Address - Country:US
Mailing Address - Phone:502-899-3623
Mailing Address - Fax:502-899-7970
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:SE #1200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3826
Practice Address - Country:US
Practice Address - Phone:502-899-3623
Practice Address - Fax:502-899-7970
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY47345207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100305640Medicaid
KYK146960Medicare PIN