Provider Demographics
NPI:1669664892
Name:KOULIEV, TIMUR (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMUR
Middle Name:
Last Name:KOULIEV
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 1:600 W DRUMMOND PL APT 512
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7218
Mailing Address - Country:US
Mailing Address - Phone:773-816-9596
Mailing Address - Fax:773-929-8731
Practice Address - Street 1:600 W DRUMMOND PL APT 512
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7218
Practice Address - Country:US
Practice Address - Phone:773-816-9596
Practice Address - Fax:773-929-8731
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-12
Last Update Date:2007-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.118977207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine