Provider Demographics
NPI:1104865476
Name:KUREK, JASON BERNARD JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:BERNARD JAMES
Last Name:KUREK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17515 W 9 MILE RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4403
Mailing Address - Country:US
Mailing Address - Phone:248-569-4000
Mailing Address - Fax:248-569-5771
Practice Address - Street 1:17515 WEST 9 MILE RD
Practice Address - Street 2:SUITE 340
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-569-4000
Practice Address - Fax:248-569-5771
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001753213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480F37288OtherBLUE CROSS BLUE SHIELD
MI3258640Medicaid
MI480023791OtherRAILROAD MEDICARE
U61766Medicare UPIN
0F37288019Medicare ID - Type Unspecified