Provider Demographics
NPI:1528368875
Name:COURI CENTER FOR GYNECOLOGY AND INTEGRATIVE WOMENS HEALTH SC
Entity Type:Organization
Organization Name:COURI CENTER FOR GYNECOLOGY AND INTEGRATIVE WOMENS HEALTH SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:A
Authorized Official - Last Name:COURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-692-6838
Mailing Address - Street 1:6708 NORTH KNOXVILLE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614
Mailing Address - Country:US
Mailing Address - Phone:309-692-6838
Mailing Address - Fax:309-691-6858
Practice Address - Street 1:6708 NORTH KNOXVILLE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614
Practice Address - Country:US
Practice Address - Phone:309-692-6838
Practice Address - Fax:309-691-6858
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COURI CENTER FOR GYNECOLOGY AND INTEGRATIVE WOMEN'S HEALTH SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-02
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty