Provider Demographics
NPI:1487892766
Name:RICHARD KURTZ MD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:RICHARD KURTZ MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIDEEN
Authorized Official - Middle Name:O
Authorized Official - Last Name:YEKINNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-926-9117
Mailing Address - Street 1:3351 N MERIDIAN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4674
Mailing Address - Country:US
Mailing Address - Phone:317-926-9117
Mailing Address - Fax:317-923-5729
Practice Address - Street 1:3351 N MERIDIAN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4674
Practice Address - Country:US
Practice Address - Phone:317-926-9117
Practice Address - Fax:317-923-5729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041627A207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200124360Medicaid
ING00010Medicare UPIN
IN898710Medicare PIN