Dr. Theodore C Koutlas, MD
Thoracic Surgery (Cardiothoracic Vascular Surgery) in Spokane, WA. Individual provider (NPI-1).
NPI number1902898331
StatusActive
Last updated in NPPESJun 16, 2021
Details
- NPI
- 1902898331
- Entity type
- Individual (NPI-1)
- Name
- Dr. Theodore C Koutlas
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 22, 2005
- Certification date
- Jun 16, 2021
- Last updated
- Jun 16, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | MD60367366 | WA | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | M-12098 | ID | |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 36754 | NC |
Practice location
62 W 7th Ave Ste 110Spokane, WA 99204-2321
Phone 509-456-0262 · Fax 509-462-5059
Mailing address
62 W 7th Ave Ste 110Spokane, WA 99204-2321
Phone 509-456-0262 · Fax 509-462-5059
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