Organization
CEP AMERICA- ILLINOIS SNF, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEOPHILE G. KOURY MD (ADMINISTRATIVE VP OF OPERATIONS)
(510) 350-2600
Entity
Organization
Contact information
Practice address
1155 N 1ST ST, BREESE, IL 62230-1735
(618) 526-4521
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
08/14/2018
Last updated
03/30/2020
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