Provider Demographics
NPI:1417744186
Name:KURTZ, JACOB WILLIAM
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:WILLIAM
Last Name:KURTZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 RUSCO RD
Mailing Address - Street 2:
Mailing Address - City:KENT CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49330-9046
Mailing Address - Country:US
Mailing Address - Phone:616-970-4151
Mailing Address - Fax:
Practice Address - Street 1:1127 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-1020
Practice Address - Country:US
Practice Address - Phone:616-970-4151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide