Individual
KOUROUS A REZAEI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
71 W 156TH ST, STE 400, HARVEY, IL 60426-4265
(708) 596-8710
(708) 596-9820
Mailing address
11516 183RD PL STE SW, ORLAND PARK, IL 60467-9471
(708) 877-1300
(708) 596-8719
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
036108868
IL
207WX0107X
Retina Specialist (Ophthalmology) Physician
01061504A
IN
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
036108868
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036108868
—
IL
01
—
P00264957
RRMC
IL
01
—
P00440893
RRMC
IN
Enumeration date
12/15/2005
Last updated
02/04/2022
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