Provider Demographics
NPI:1063417152
Name:KURZ, PAUL ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALLEN
Last Name:KURZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-2287
Mailing Address - Country:US
Mailing Address - Phone:503-901-1531
Mailing Address - Fax:
Practice Address - Street 1:330 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2287
Practice Address - Country:US
Practice Address - Phone:503-901-1531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.083570207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4589915Medicaid
MIH657810Medicare UPIN
MI4589915Medicaid