Organization
CEPAMERICA ILLINOIS LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEOPHILE KOURY MD (VPO)
(510) 350-2600
Entity
Organization
Contact information
Practice address
600 S RANDALL RD, ALGONQUIN, IL 60102-5935
(847) 429-4300
Mailing address
1601 CUMMINS DR STE D, MODESTO, CA 95358-6411
(510) 350-2600
(510) 879-9100
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Enumeration date
11/01/2011
Last updated
04/01/2020
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