# GEORGE JOHN KOULLIAS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1992986509
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 036119605 | IL | Yes |

## Other

- **Enumeration date:** 11/26/2007
- **Last updated:** 11/14/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 03619605 | IL LICENSE | IL |
| 01 | — | 039729 | CT LICENSE | CT |
| 01 | — | 262079 | MEDICAL BOARD-NY STATE | NY |