Individual
NICHOLAS KOUCHOUKOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3023 N BALLAS RD STE 150D, SAINT LOUIS, MO 63131-2319
(314) 996-5287
(314) 432-6068
Mailing address
3023 N BALLAS RD STE 150D, SAINT LOUIS, MO 63131-2319
(314) 996-5287
(314) 432-6068
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
28052
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202103727
—
MO
Enumeration date
08/31/2006
Last updated
03/11/2019
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