Organization
JOVIVE HEALTH - ILLINOIS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEOPHILE G. KOURY MD (ADMIN VICE PRESIDENT OF OPERATIONS)
(510) 350-2600
Entity
Organization
Contact information
Practice address
601 E ROOSEVELT RD, LOMBARD, IL 60148-4740
(312) 858-5112
Mailing address
2100 POWELL ST STE 400, EMERYVILLE, CA 94608-1826
(510) 350-2600
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
09/14/2021
Last updated
03/17/2022
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