Provider Demographics
NPI:1568412773
Name:KOURI, THOMAS F (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:KOURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5401 N KNOXVILLE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5098
Mailing Address - Country:US
Mailing Address - Phone:309-689-9088
Mailing Address - Fax:309-689-1037
Practice Address - Street 1:5401 N KNOXVILLE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5098
Practice Address - Country:US
Practice Address - Phone:309-689-9088
Practice Address - Fax:309-689-1037
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071029Medicaid
IL110228165OtherRAILROAD MEDICARE
IL110228165OtherRAILROAD MEDICARE
ILC46233Medicare UPIN