Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 5901001753 | MI |
Y | 222Z00000X | Podiatrist | 5901001753 | MI |
N | 213EP1101X | Primary Podiatric Medicine | 5901001753 | MI |
NPI | 1104865476 |
---|---|
Provider Name | Dr. Jason Bernard James Kurek |
First Address | Southfield, MI 48075-4403 |
Second Address | Southfield, MI 48075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 26/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3258640 | (05) | MI |
480023791 | RAILROAD MEDICARE (01) | MI |
480F37288 | BLUE CROSS BLUE SHIELD (01) | MI |
U61766 | (02) |