Provider Demographics
NPI:1982606349
Name:COUKOS, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:COUKOS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:340 MAIN ST
Mailing Address - Street 2:SUITE 670
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1604
Mailing Address - Country:US
Mailing Address - Phone:508-754-3566
Mailing Address - Fax:508-798-8012
Practice Address - Street 1:11 NEVINS ST
Practice Address - Street 2:SUITE 503
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3514
Practice Address - Country:US
Practice Address - Phone:617-782-1200
Practice Address - Fax:617-782-1521
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA57264208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3045765Medicaid
MAJ08415Medicare ID - Type Unspecified
MA3045765Medicaid