Provider Demographics
NPI:1194718957
Name:GIRICZ, KURT JOSEPH (DO)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:JOSEPH
Last Name:GIRICZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-0800
Mailing Address - Country:US
Mailing Address - Phone:219-864-2107
Mailing Address - Fax:219-864-2649
Practice Address - Street 1:840 RICHARD RD
Practice Address - Street 2:SUITE #3
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1994
Practice Address - Country:US
Practice Address - Phone:219-322-1450
Practice Address - Fax:219-322-8260
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000356A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0090000854OtherBCBS GROUP NUMBER
IN100462520Medicaid
IN140220HHHMedicare PIN
IL0090000854OtherBCBS GROUP NUMBER