Provider Demographics
NPI:1134218399
Name:COURET, LUIS A (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:COURET
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 1:2930 MANNHEIM RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-2265
Mailing Address - Country:US
Mailing Address - Phone:847-451-4064
Mailing Address - Fax:847-451-4098
Practice Address - Street 1:2930 MANNHEIM RD
Practice Address - Street 2:SUITE #1
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-2265
Practice Address - Country:US
Practice Address - Phone:847-451-4064
Practice Address - Fax:847-451-4098
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090038207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632309OtherBCBS OF IL PROVIDER
110235189OtherRR MEDICARE PROVIDER #
IL14D1010159OtherIL CLIA #
IL036090038Medicaid
043632612OtherTAX ID
IL036090038Medicaid
ILK10653Medicare PIN