Individual
KATHERINE FACKLIS KOUVELIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1221 N HIGHLAND AVE, AURORA, IL 60506-1404
(630) 859-8700
Mailing address
2357 SEQUOIA DR, AURORA, IL 60506-6222
(630) 859-6800
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036118061
IL
208C00000X
Colon & Rectal Surgery Physician
036118061
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0451514334
BLUESHIELD PROVIDER#
IL
Enumeration date
08/09/2005
Last updated
04/15/2025
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