Provider Demographics
NPI:1891773321
Name:KOUTOUZIS, THEODORE KYPREOS (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:KYPREOS
Last Name:KOUTOUZIS
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 1:211 E ONTARIO
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-694-7000
Mailing Address - Fax:
Practice Address - Street 1:211 E ONTARIO ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3468
Practice Address - Country:US
Practice Address - Phone:312-694-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-102893207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL930122248OtherRRMCR
FL13032OtherBCBS
FL264218200Medicaid
FL13032ZMedicare ID - Type Unspecified
FL264218200Medicaid