Organization
CEP AMERICA -ILLINOIS PC
Active
Organization
CEP AMERICA -ILLINOIS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEOPHILE KOURY MD (ADMIN VICE PRESIDENT OF OPS)
(510) 350-2842
Entity
Organization
Contact information
Practice address
2112 S MICHIGAN AVE, CHICAGO, IL 60616-1704
(630) 372-1100
Mailing address
1601 CUMMINS DR STE D, MODESTO, CA 95358-6411
(510) 350-2842
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
07/30/2020
Last updated
05/12/2021
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