Provider Demographics
NPI:1841341179
Name:KOURIS, GEORGE J (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:KOURIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1611 W HARRISON ST.
Mailing Address - Street 2:212
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-432-2850
Mailing Address - Fax:312-563-2545
Practice Address - Street 1:1611 W HARRISON ST
Practice Address - Street 2:212
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4861
Practice Address - Country:US
Practice Address - Phone:312-432-2850
Practice Address - Fax:312-563-2545
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2012-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-108015208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108015Medicaid
IL1634518OtherBLUE CROSS BLUE SHIELD IL
IL1634518OtherBLUE CROSS BLUE SHIELD IL