Organization
CEP AMERICA - ILLINOIS SNF, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEOPHILE KOURY M.D (ADMINISTRATIVE VP OF OPERATIONS)
(510) 350-2600
Entity
Organization
Contact information
Practice address
2 ANNABLE CT, CAHOKIA, IL 62206-2204
(618) 332-0114
Mailing address
1601 CUMMINS DR STE D, MODESTO, CA 95358-6411
(510) 350-2600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
11/15/2018
Last updated
03/30/2020
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