Provider Demographics
NPI:1639142664
Name:COURI, DANIEL M (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:COURI
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 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:651-241-2780
Mailing Address - Fax:651-241-2785
Practice Address - Street 1:225 SMITH AVE N
Practice Address - Street 2:STE 400
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2533
Practice Address - Country:US
Practice Address - Phone:651-241-2780
Practice Address - Fax:651-241-2785
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-126056207RC0000X
MN46961207RC0000X
IL036126056174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00391252OtherRAILROAD MEDICARE
IL036126056Medicaid
MN787662900Medicaid
MN787662900Medicaid
MN110009953Medicare PIN
MNP00391252OtherRAILROAD MEDICARE