Provider Demographics
NPI:1396731485
Name:JURISICH, STEVEN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:JURISICH
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1139 CARTHAGE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4111
Mailing Address - Country:US
Mailing Address - Phone:919-775-7232
Mailing Address - Fax:919-775-1731
Practice Address - Street 1:1139 CARTHAGE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4111
Practice Address - Country:US
Practice Address - Phone:919-775-7232
Practice Address - Fax:919-775-1731
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9300171208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E73917Medicare UPIN
NC2190990AMedicare PIN