Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 47345 | KY |
NPI | 1093081713 |
---|---|
Provider Name | Dr. Maria Koutourousiou |
First Address | Louisville, KY 40202-2877 |
Second Address | Louisville, KY 40202-3826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2012 |
Last Update Date | 08/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100305640 | (05) | KY |