Basic Information
| Provider Information | |||||||||
| NPI: | 1225314495 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOURTIDOU | ||||||||
| FirstName: | SOULTANA | ||||||||
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| Credential: | MD, MSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 11TH ST APT 10B | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112154537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165031010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 263 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112157247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187805260 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2011 | ||||||||
| LastUpdateDate: | 11/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | 296478 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
No ID Information.