Individual
DR. MICHAEL DEMETRIOS KOUIMELIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9951 ROCK CUT XING, LOVES PARK, IL 61111-1999
(815) 639-8500
(815) 639-8501
Mailing address
9951 ROCK CUT XING, LOVES PARK, IL 61111-1999
(815) 639-8500
(815) 639-8501
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036121741
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036121741
—
IL
01
—
553180
MEDICARE GROUP #
IL
01
—
834370
MEDICARE GROUP #
IL
Enumeration date
07/10/2008
Last updated
01/28/2021
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