Provider Demographics
NPI:1154306389
Name:KOURIS, STEVEN (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:KOURIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 PARKVIEW AVE
Mailing Address - Street 2:CREDENTIALING S200
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1822
Mailing Address - Country:US
Mailing Address - Phone:815-395-5851
Mailing Address - Fax:815-395-5644
Practice Address - Street 1:1601 PARKVIEW AVE
Practice Address - Street 2:UNIVERSITY PSYCHIATRIC SERVICES
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1822
Practice Address - Country:US
Practice Address - Phone:815-395-5870
Practice Address - Fax:815-395-5644
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE63807Medicare UPIN
IL375820Medicare ID - Type UnspecifiedMEDICARE PROV ID#