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Individual

DR. MICHAEL T COURIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3969 4TH AVE, SUITE 301, SAN DIEGO, CA 92103-3165
(619) 291-6191
(619) 291-0049
Mailing address
3969 4TH AVE, SUITE 301, SAN DIEGO, CA 92103-3165
(619) 291-6191
(619) 291-0049

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
A53265
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00A532650
BLUE SHIELD
CA
05
00A532650
CA
01
00A532651
MEDICARE-SPECTRUM
CA
01
180046485
PALMETTO GBA
CA
01
4401850001
DMERC
CA
01
522450085
TAX ID
CA
01
5224500859210300
CHAMPUS
CA
01
A53265B
MEDICARE PIN-SPECTRUM
CA
01
P00353462
RAILROAD MEDICARE
CA
Enumeration date
04/18/2007
Last updated
03/02/2012
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