Provider Demographics
NPI:1851433445
Name:KOULOURIS, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:KOULOURIS
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 1:32 GISBORNE ST
Mailing Address - Street 2:
Mailing Address - City:BULLEEN
Mailing Address - State:VICOTRIA
Mailing Address - Zip Code:3105
Mailing Address - Country:AU
Mailing Address - Phone:0116141-057-6626
Mailing Address - Fax:
Practice Address - Street 1:THE ALFRED HOSPITAL, RADIOLOGY DEPT
Practice Address - Street 2:COMMERCIAL RD
Practice Address - City:PRAHRAN
Practice Address - State:VICTORIA
Practice Address - Zip Code:3181
Practice Address - Country:AU
Practice Address - Phone:0116139-276-2118
Practice Address - Fax:01139-276-2988
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT185594174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist